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Full text of "A course of examinations on anatomy and physiology, surgery, chemistry, materia medica, midwifery, and the practice of medicine : adapted to the University of Pennsylvania, and the other medical schools in the United States"

COURSE OF EXAMINATIONS 



ANATOMY AND PHYSIOLOGY, SURGERY, 

CHEMISTRY, MATERIA MEDICA, 

MIDWIFERY, 



THE PRACTICE OP MEDICINE. 

ADAPTED TO THE 

UNIVERSITY OF PENNSYLVANIA, 

AWD THE OTHER MEDICAL SCHOOLS IN THE UNITED STATES^ 



BY DAVID F. CONDIE, M. D. 



» 1 2 



PHILADELPHIA*^ ^ S ' / 'xk 

PUBLISHED BT J- WEBSTER 24, s; EIGHTH STREET. 

VTilhatn Brown, Printer. 

1818. 



lain, 



Eastern District of Pennsylvania, to wit : 

Be it remembered, That on the eighth day of 
Dect mber, in tht forty-third year of the independence 
of the United States of America, A. D 181S, James 
Webster, of the said district, hath deposited in this of- 
fice the title of a book, the right whereof he claims as 
proprietor, in the words following, to wit : 

" A Course of Examinations on Anatomy and Physiolo- 
gy, Surgery, Chemistry, Materia Medica, Midwifery, 
and the Practice of Medicine, adapted to the Uni- 
versity of Pennsylvania, and the other medical schools 
in the United States. By David F. Condie, M. D." 

In conformity to the act of the congress of the United 
States, entitled, "An act for the encouragement of 
learning, by securing the copies of maps, charts, and 
books, to the authors and proprietors of such copies, 
during the times therein mentioned." — And also to the 
act, entitled, " An act supplementary to an act, entitled, 
* An act for the encouragement of learning, by securing- 
the copies of maps, charts, and books, to the authors 
and proprietors of such copies during the times therein 
mentioned,' and extending the benefits thereof to the 
arts of designing, engraving, and etching historical and 
other prints." 

D. CALDWELL, 
Clerk of the Eastern District of Pennsylvania. 



TO 

THOSE GENTLEMEN 

THROUGHOUT THE UNITED STATES) 
WHO ARE ENGAGED 

IN THE STUDY OF MEDICINE; 

FARTICULAIU.Y TO 

UCH OF THEM AS ARE PREPARING TO UNDERGO 
AN EXAMINATION, 

THIS HUMBLE ATTEMPT 

TO 

FACILITATE THEIR LABOURS, IS RESPECTFULLY 
DEDICATED 

BY THE AUTHOR. 



CONTENTS 



Page 
SECTION I. Examinations on Anatomy and Phy- 
siology, . . . . . ■ 1 

II. Examinations on Surgery, . 39 

III. Examinations on Chemistry, . 89 

IV. Examinations on Materia Medica, 117 

V. Examinations in Midwifery, . 122 

VI. Examinations on the Practice of 
Medicine, .... 141 



A COURSE 

OF 

EXAMINATIONS, $c. 

SECTION I. 

Examinations on Anatomy and Physiology. 

Question. Are bones inorganic concretes ? 

Answer. No : they are regularly organized bodies, 
containing blood-vessels, absorbents, &c. This is prov- 
ed by the fact, that bones are capable of the process of 
ulceration, granulation, &c, and by the re-union of 
bones when fractured. Their vessels may be rendered 
evident by injection and subsequent maceration in a 
corroding liquor. 

Q. What forms the solid basis of bones ? 

A. Principally the phosphate of lime. 

Q. What is the theory of ossification ? 

A. The bones at first consist of a jelly, which is af- 
terwards converted into cartilage ; the absorbents now 
remove a portion of the cartilage, and form cavities 
into which the arteries deposit the osseeus matter. 
Sometimes, however, the bony matter is deposited be- 
tween membranes, in place of in cartilage, which is 
the case in the flat bones. 

Q. AVhat is the membrane called which invests the 
hones ? 

A. It is called periosteum. 

Q. What do you mean by epiphyses ? 

A. Thev are those portions of the bones of the i» 
A 



2 AN ATOM V AM) 

fant, which arc separable from the banc to which I 
belong-, but which, in the adult, adhere and becom 
part of the bone. 

Q. Into how manv parts is the scull divided ? 

A. Into the bones of the cranium, and those of the 
face. 

Q What bones compose the cranium ? 

A. The os froTitis, ossa parietalia, ossa temporum, 
os occipitis, os elhmoides, and os sphenoides. 

Q What do you mean by apophyses ? 

A. They are the processes or projecting parts ol 
bones. 

Q. How are the bone9 of the cranium united I 

A. The) are united by suture. 

Q. How many bones compose the face ? 

A. Thirteen; viz. The two ossa maxilaria superiora, 
the two ossa malarum, the two ossa nasi, the two ossa 
lacrymalia, the two ossa palati, the two ossa turbinata 
inferiora, and the vomer. 

Q How many tables have the bones of the cranium 

A. Two ; an internal and an external. 

Q. What suture connects the frontal with the pari- 
etal '>ones ? 

A. The coronal. 

Q Describe trie frontal bone. 

A The frontal bone has some resemblance to the ! 
shell of the clam ; it is placed at the anterior part of 
the scull, and forms the forehead and upper parts of 
the orbits. It receives the anterior lobes of the cere- 
brum, has a notch, between its orbital processes, for 
the ethmoid bone ; is internally concave and externally 
convex, having several elevations and depressions. 

Q. What name has been given to the internal table 
of the bones of the scull? 

A. It has been called vitreous, from its supposed 
glassy appearance. 

Q. What is the periosteum of the bones of the err; 
nium called > 

A. Pericranium. 



PHYSIOLOGY. 3 

Q. Wliat is tin; substance uniting llie two tables of 
Uie bones of the cranium call< d .- 

A. Diploe. It is ofa cellular structure. 

Q. By what suture is the occipital bone united to the 
parietal ? 

A. By the lambdoidal. 

Q. How many bones compose the orbit ? 

A. A portion of seven; viz. of the frontal, ethmoidal, 
sphenoidal, palatine, unguis, superior maxillary, and the 
malar; , 

Q. Describe the situation of the sphenoidal bone. 

A. The sphenoidal bone is situated in the middle of 
the basis of the cranium, extending underneath, from 
one temple to the other. 

Q. To what bones is the frontal connected ? 

A. Superiorly to the parietal, posteriorly and interi- 
orly to the sphenoid, and interiorly to the bones of the 
face. 

Q. By what suture are the parietal bones connected' 

A. By the sagittal. 

Q. Describe the parietal bones. 

A. They are nearly ofa quadrangular shape, convex 
externally, and concave internally. They are situated 
at the superior and lateral parts of the scull, forming a 
covering to the middle lobes of the brain. 

Q. To what bone does the crista galli appertain ? 

A. To the ethmoid ; it forms a projecting process 
within the cranium, to which the beginning of the 
falciform ligament of the dura mater is attached 

Q. To what bone does the >ella turcica belong ! 

A. To the sphenoid; it is placed in the middle, and 
projects into the cavity of the cranium. 

Q. By what suture are the temporal bones connect* 
ed to the parietal ? 

A. By the squamous. 

Q. What composes the septum narium, in there- 
cent subject ? 

A. The nasal lamella of the ethmoid bone, the vo- 
mer, and anteriorly a portion of cartilage. 



4 ANATOMY AND 

Q. What is situated in llic sella turcica 

A. The pituitary gland. 

Q. Describe the temporal bones. 

A. Each temporal bone is divided into three parts, 
a squamous or upper portion, which is of a semicircu- 
lar form, and smooth externally; a mastoid portion, 
situated posteriorly, and a petrous portion, which is 
nearly triangular, projecting internally and forwards. 
They are situated at the lower part of the side and ba- 
sis of the cranium. 

Q. How many parts open into the nose ? 

A. The frontal, ethmoidal, and sphenoidal celb; 
the maxillary sinus, and the lacrymal duct. 

Q. What is the situation of the great occipital fora- 
men ? 

A. Tn the occipital bone, at the inferior part, between 
the condyles, and behind the cuneiform process. 

Q. To what bones are each of the parietal connect- 
ed? 

A. To its fellow laterally, anteriorly to the os fron- 
tis, interiorly to the os temporis, posteriorly to the os 
occipitis, and by its anterior inferior angle to the os 
sphenoides. 

Q. Where is the os ethmoides situated ? 

A. At the root of the nose, between the two orbitar 
processes of the os frontis. 

Q. What is the form and structure of the ethmoid 
bone ! 

A. It is nearly a cube in form, and perfectly cellular. 

Q. In what bone do we find the antrum maxillare, 
or highmorianum ! 

A. tn the superior maxillary. 

Q What occasions the difference between the size 
of the opening of this sinus into the nose, in the ske- 
leton and in the recent subject ? 

A. In the recent subject it is partly closed by a por- 
tion" of the paiate-bone, by a portion of the os unguis, 
and by the inferior turbinated bone. 

<}. In what bone is the organ of hearing situated : 



PHYSIOLOGY. 5 

in the petrous portion of tlie temporal. 

Q. What bone separates the ethmoid from the occi- 
pital ? 

A. The sphenoid. 

Q. To what bones are the temporal connected? 

A. Anteriorly, to the sphenoid bone ; superiorly, to 
the parietal ; posteriorly, to the occipital ; and to the 
lower jaw, by ginglymus articulation. 

Q. To what bone do the superior turbinated bones 
belong ? 

A. They are a part of the ethmoid. 

Q. How many teeth are there in the adult ? 

A. Thirty-two; sixteen in each jaw. 

Q. How many bones are contained within the cavity 
of the tympanum ? 

A. Four-, viz. The malleus, incus, os orbiculare, 
and the stapes; they are articulated one to the other, 
and form a kind of chain from the membrana tympani, 
to which the malleus is attached, to the labyrinth. 

Q. Of what substances are the teeth composed >. 

A. They consist of two substances, being- internally 
bony, and externally covered by enamel, which is very 
hard, ana apparently unorganized. 

<i What separates the antrum highmorianum from 
the orbit ? 

A. The orbitar plate, or process of the superior max- 
illary bone. 

Q. To what bones is the ethmoid connected ? 

A. To the frontal, nasal, superior maxillary, pala- 
tine, sphenoidal, and to the vomer. 

Q. Into how many portions is each tooth divided? 

A. Into its corona, or that portion which is exterior to 
the socket ; its neck, or the narrow part which is en- 
compassed by the gum ; and its roots, which are either 
one, two, or three processes proceeding from ihe neck, 
and contained within the socket. 

Q. "Where are the ossa nasi situated ? 

A. They form the arch of the nose. 

Q. Describe the occipital bone. 



AN ATOM V ANb 

A. It is irregularly rhomboidal, its interior angle 
projecting forward, which part is called the cuneiform 
process : while its superior one is rounded, and its la- 
teral angles are obtuse- It is concave internally, and 
convex externally. It is situated at the posterior and 
interior part of the cranium, supporting the cerebellum 
and medulla oblongata, giving exit through its fora- 
men magnum to the spinal marrow, and connecting, by 
means of its condyles, the head with the trunk. 

Q. Into how many classes are the teeth arranged 1 

A. Into the incisores, cuspidati, bicuspides, and 
TOolares. 

Q What arc the situation and number of each of these 
classes ? 

A. The incisores are the four broad teeth, situated 
hi tin front of each jaw ; the cuspidati, or canine teeth, 
are two in number, and are situated one on each side 
of the incisftrs ; next to the cuspidati are placed the 
bicuspides, there being two on each side ; and finally, 
on either side of the bicuspides are situated three me- 
lares, or grinders, in each jaw. 

O. Where is the vomer situated i 

A. In the centre of the nostrils ; having the sphenoid 
and ethmoid bones at its upper part, and the superior 
maxillary and palate bones at its lower part, and the 
cartilaginous septum of the nose anteriorly. 

Q. To what bones is the os sphenoides connected ? 

A. To the frontal, ethmoidal, malar, palatine, max 
illary, occipital, parietal, and to the vomer. 

Q. Where are the ossa unguis situated ? 

A. At the anterior edge of the inner angle of" each 
orbit. 

Q. How many teeth compose the first or infantile 
set? 

A. Twenty; viz. eight incisors, four canine, and 
eight molar. 

Q. Where are the ossamalarum situated I 

A. They form the prominence of the cheeks. 

Q. To what bones is the occipital connected 



PHYSIOLOGY. 7 

\. Anteriorly to the sphenoid; superiorly, to the 
parietal ; laterally, to the temporal ; and inferiorly, to 
the atlas, by ginglymus articulation. 

Q. At what time of life do the teeth begin to appear 
through the gums ? 

A. They begin to appear generally about the sixth 
month, and are completed by the second year. 

Q. What is the situation of the ossa palati ? 

A. They are placed at the posterior part of the orbit, 
nares, and palate. 

Q. At what age do the first set of teeth begin to be 
shed ? 

A. They begin to be shed at about seven years of 
age, and the process is generally finished, and the per- 
manent set completed, by the fourteenth year, excepting 
t lie two last molares, which do not appear until about 
the twenty-first year. 

Q How is the shedding of the teeth effected ! 

A. By the absorption of the fangs of the first set, 
and also of their sockets. 

Q. What is contained within the cranium ? 

A. The brain with its membranes, and the com- 
mencement of the nine first pair of nerves. 

Q. Into how many parts is the brain divided ? 

A. Into the cerebrum, cerebellum, pons varolii, and 
medulla oblongata. 

Q. By what openings do the first pair of nerves pass 
out of the cranium ? 

A. Through the foramina of the cribriforme plate of 
llie os ethmoides. 

Q. What bones form the foramen lacerum at the ba- 
sis of the cranium \ 

A. The temporal and occipital. 

Q. What parts does the foramen lacerum, at the ba- 
ils of the cranium, transmit ? 

A. The jugular vein and the par vagum. 

Q. By what membranes is the brain enveloped ? 

A. By the dura, and pia maters, and the tunica 
arachnoides. 



a ANATOMY AND 

Q. What do you mean by the falx cerebri I 

A. It is a duplicative of the dura mater, which 
passes down between the two hemispheres of the ce- 
rebrum, and extends from the crista galli, along the 
sagittal suture, and to the middle of the temporal 
bone. 

Q. Of what substances is the mass of the brain said 
to consist ? 

A. Of two ; an external, called the cortical or cene- 
ritious, which is of a reddish colour ; and an internal, 
called the medullary, which is perfectly white. 

Q. Through what foramina do the optic nerves pass 
out of the cranium ? 

A. Through the foramina optica of the sphenoid 
bone. 

Q. What are the cavities in the brain called ? 

A. Ventricles. 

Q. Mow many are there ? 

A. Four. 

Q. What vessel is contained in the upper edge of the 
falx cerebri. 

A. The great longitudinal sinus. 

Q. What do you mean by the tentorium ? 

A. It is a horizontal process of the dura mater, 
.stretched across the posterior part of the caviiy of the 
cranium, and is attached, along the grooves of the late- 
ral sinuses, on the occipital bone, and to the angles of 
lie petrous portions of the temporal bones, and termi- 
nates at the posterior clinoid processes of the sphenoid 
bone, being situated between the cerebrum and cere- 
bellum, supporting the posterior lobes of the former- 

Q. Through what foramina do the third, fourth, and 
sixth pair of nerves pass out of the cranium ? 

A. Through the foramina lacera of the sphenoid 
bone. 

Q. What do you mean by the carpus callosum ? 

A. It is an oblong white body, which forms the bot- 
tom of the fissure which divides the two hemispheres 
of the cerebrum ; through the middle of it runs a 



PHYSIOLOGY. a 

groove, denominated its raphe, bounded on each side 
by a small medullary chord. 

Q. Through what foramen does the internal carotid 
pass into the cranium ? 

A. Through the carotid foramen, which is situated 
in the petrous portion of the temporal bone. 

Q. What is the situation of the lateral ventricles ? 

A. They are situated in the centre of the brain, im- 
mediately under the corpus callosum. 

Q. What separates them from each other ? 

A. The septum lucidum. 

Q. Through what foramina do the eighth pair of 
nerves pass out of the cranium ! 

A. Through the foramina lacera at the basis of the 
cranium, along with the jugular veins. 

Q. What do you mean by the corpora striata ? 

A. They are two pyriform eminences, situated at the 
bottom of the anterior and outer part of the lateral 
ventricles, with their larger extremities forwards; they 
are composed of alternate striae of medullary and cor- 
tical matter. 

Q. What is the situation of the third ventricle of the 
brain ? 

A. It is situated between the two thalami nervorum 
oplicorwm. 

Q. What is the appearance and situation of the pi- 
neal gland ? 

A. It is an irregularly round, and sometimes conical 
body, situated behind the thalami nervorum opticorum, 
to which it is connected by two medullary chords, call- 
ed its peduncles, and resting upon the tuberculaquad- 
i igemina ; it consists mostly of cortical substance, and 
frequently contains a sandy matter. 

Q. Through what foramina do the ninth pair of 
nerves pass out of the cranium ? 

A. Through the anterior condyloid foramen, in the 
occipital bone. 

Q. What do yon mean by the thalami nervorum op- 
ticorum ? 



lii ANATOMY AND 

A. They are two bodies, or an oval shape, and con- 
vex superiorly, situated in the brain, between tlte pos- 
terior extremities of the corpora striata, and covered 
by the fornix. 
'Q. What is the situation oFthe fourth ventricle ? 

A. It is situated behind the tubercula quadrigemina, 
between the cerebellum, the under part of the pons 
varolii, and the upper part of the medulla oblongata. 

Q. What do you mean by the fornix ? 

A. It is a medullary body, situated immediately un- 
der the septum lucidum, and over the lhalami nervo- 
rum opticorum ; of a triangular form, with its basis 
presenting posteriorly. 

Q. What is the medulla oblongata ? 

A. It is a large medullary body, situated in the mid- 
dle of the basis of the brain ; it is formed by the union 
of the crura of the cerebrum and cerebellum, and ter- 
minates posteriorly in the medulla spinalis. 

Q. What is the situation of the pons varolii ? 

A. It is situated at the basis of the cranium, over 
the place where the crura of the cerebrum and cere- 
bellum unite to form the medulla oblongata. 

Q. What separates the cavity of the third, from the 
cavity of the fourth, ventricle ? 

A. A thin medullary lamina, called the valve of 
Vieussens, or the valve of the brain. 

Q. Describe the spine. 

A. The spine is a long, bony, and cartilaginous, hol- 
low column, consisting of twenty-four bones, or ver- 
tebrae, and extending from the occipital bone to the os 
.sacrum. 

Q. Into how many classes are the vertebrae divided ? 

A. Into three ; viz. the seven first are denominated 
cervical; the twelve next, dorsal; and the five inferior 
ones, lumbar. 

Q. Of how many parts is each vertebra; composed > 

A. Of its body, a bony ring, and of seven processes ; 
viz. two transverse, four oblique, or articulating, and 
of one spinous, projecting backwards. 



PHYSIOLOGY 11 

Q. What are the distinguishing marks of a cervical 
vertebra > 

A. The body is flattened anteriorly, and is thinner 
than the other vertebrae; its upper side is concave from 
side to side, and its lower, hollowed from before back- 
ward ; the spinous processes are more straight, and 
bifurcated at the extremity ; the transverse processes 
are very short, slightly bifurcated, and perforated per- 
pendicularly at their bases ; they are also grooved in 
the upper side. The oblique processes are more ob- 
lique, their articulating surfaces in the upper ones be- 
ing turned backwards and upwards, and in the inferior 
forward and downwards. 

Q. What are the peculiarities of the first vertebra ? 

A. It has no body nor spinous process. Its trans- 
verse processes are longer than those of the rest, and 
terminate in an obtuse point. The superior articular 
processes are larger than the rest, and form oblong ho- 
rizontal cavities lor the reception and articulation of the 
condyles of the os occipitis. 

Q. What are the distinguishing marks of a lumbar 
vertebra ? 

A. The body is much larger than that of any of the 
other vertebrae ; its spinous processes are short, 
straight, and broad on each side, but narrow above and 
below. The transverse processes are longer and more 
slender than in the other vertebrae, and are flattened 
anteriorly and posteriorly ; they increase in length, 
from the first to the third, then diminish to the fifth. 
The superior articular processes are concave ; the in- 
ferior convex, lengthwise. 

Q. What are the peculiarities of the vertebra den- 
tata? 

A. Its body is narrow and long, and it has upon its 
upper part a pivot or process, denominated dentatus, 
upon which the first vertebra turns, when the head is- 
rotated to one side. 

Q. What is contained in the cavity of the spine ? 

A. The medulla spinalis. 



12 ANATOMY AND 

Q. What parts compose the bony thorax ! 

A. Posteriorly, the dorsal vertebra; ; laterally, the 
ribs ; and anteriorly, the sternum. 

Q. What parts complete the cavity of the thorax, in 
the recent subject ? 

A. The intercostal muscles and the diaphragm. 

Q. How many ribs are there ? 

A. There are twelve on each side. 

Q. Of how many parts is the sternum composed I 

A. Of three. 

<-i. Into how many classes are the ribs divided ? 

A. Into two ; the seven first on each side, wind, are 
attached, by their cartilages, immediately to the ster- 
num, are denominated true ribs; the five others, the 
cartilages of which are either attached to the cartilages 
of those above them, or remain unconnected, are call- 
ed false ribs. 

Q. What are the distinguishing marks of the dorsal 
vertebra I 

A. Their bodies are most convex anteriorly ; their 
upper and lower surfaces are nearly flat, and on each 
side, there are two small articulating surfaces, one 
above, and one below, to receive the heads of the ribs. 
The spinous processes are long and sharp ; slightly 
hollowed below, and sharp above, and considerably in- 
clined downwards. The articulating processes are al- 
most directly above and below the transverse, and are 
perpendicular rather than oblique. The transverse 
processes are pretty long superiorly, but diminish as 
they descend. The anterior part of their tips is cover- 
ed with cartilage, and receives the tubercles of the 
ribs ; these depressions diminish as they descend, and 
do not exist at all in the two last. 

Q. In what does the first, and two last ribs, differ 
from the rest ? 

A. The first rib differs from the rest, in being placed 
horizontally ; in having its head connected with only 
one vertebra; in having no groove in its inferior edge; 
and in being connected to the sternum without the 'in- 



PHYSIOLOGY. U 

tervention of a cartilage. The two last have their heads 
connected each to one vertebra only. They have no 
connection with the transverse processes ; there is no 
groove in their inferior edge, and their cartilages are 
neither directly nor indirectly connected with the ster- 
num. 

Q- What is contained in the cavity of the thorax ? 

A. The heart and great vessels, and the pericardi- 
um ; the lungs, the oesophagus, and, in the foetus, the 
thymus gland. 

Q. What is situated in the groove, at the lower and 
internal edge of each rib ? 

A. The intercostal artery, vein, and nerve. 

Q. By what membrane is the cavity of the thorax 
lined ? 

A. By the pleura, which also covers the different 
viscera, and divides the thorax into two cavities. 

Q. Between what muscles does the subclavian artery 
pass, as it goes over the first rib in its exit from the 
thorax ? 

A. Between the anterior and middle scalenus mus- 
cles. 

Q. Describe the heart. 

A. It is a hollow muscular organ, which receives 
the blood from, and transmits it to, all the different 
parts of the body. It is somewhat of a conical form, 
but is flattened on its inferior side ; it is invested by 
the pericardium, and rests upon the diaphragm, in the 
middle cavity of the mediastinum. 

Q. What are the arteries given off by the thoracic 
aorta ? 

A. The bronchial, the oesophageal, and the inferior 
intercostal arteries. 

Q. What do you mean by the mediastinum ? 

A. It is a duplicature of the pleura, which passes 
from the spine to the sternum, dividing the thorax into 
two cavities. 

Q. Of how many lobes do the lungs consist > 
B 



14 ANATOMY AND 

A. The right lung is divided into three lobes, theleK 
into two. 

Q. How many openings has the right auricle of the 
heart ? 

A. Three ; viz. the openings of the two cavx, and of 
the coronary vein. 

Q. By what arteries is the heart nourished ? 

A. By the coronary. 

Q. What are those glands called, which are situated 
at the root of the lungs ? 

A. The bronchial glands ; they are of a dark colour. 

Q. What prevents the regurgitation of the blood 
from the right ventricle into the right auricle, when the 
former contracts ? 

A. The tricuspid valve. 

Q. What is the use of the lungs ? 

A. The blood, in passing through them, is converted, 
from a dark purplish colour, into a bright scarlet, and 
has also its temperature increased. 

Q. What do you mean by the cordae tendinex ? 

A. I mean those tendinous chords which connect the 
columns earner to the valves of the heart. 

Q. What divides the two lungs from each other ] 

A. The mediastinum. 

Q. What are the valves at the origin of the aorta 
called ? 

A. They are called the semilunar, and are three in 
number. 

Q. How many openings has the left auricle of the 
heart ? 

A. Four; which are the openings of the four pulmo- 
nary veins. 

Q. What prevents the blood from passing back into 
the left auricle, on the contraction of the left ventricle I 

A. The mitral valve. 

Q. Which are the nutrient vessels of the lungs ? 

A. The bronchial ; which arise immediately from 
the aorta. 

Q Where does the heart receive its nerves from ! 



l>HYSIOLOG\. 15 

, A. Principally from the cardiac plexus. 

Q. Where do we find the valve of Eustachius ? 

A. It is a fold of the inner membrane of the right 
auricle, and is situated to the left of the opening of the 
inferior cava. 

Q. Where do the lungs receive their nerves from ? 

A. From the eighth pair, and the great sympathetic. 

Q. What do you mean by the musculi pectinati ? 

A. I mean a number of muscular eminences, found 
principally on the parietes of the right auricle, and sup- 
posed to have some resemblance to the teeth of a 
comb. 

Q. How many cavities are formed within the dupli- 
cature of the mediastinum ? 

A. Three ; an anterior, containing the thymus gland, 
in the foetus ; the middle, containing the heart and pe- 
ricardium ; and the posterior, containing the bronchia, 
oesophagus, descending aorta, the descending cava, the 
vena azygos, the thoracic duct, the par vagum, and 
great sympathetic nerve. 

Q. What is meant by the columnae carnex ? 

A. They are fleshy pillars, which arise from the sides 
of the ventricles, and are attached, by means of the 
cordae tendinese, to the vakves. 

Q. What is the mechanism of respiration ? 

A. The intercostal muscles contract, and raise the 
ribs. T Ue ribs being placed sloping obliquely down- 
wards, of course, when they are raised, carry off the 
sternum to a greater distance from the spine, and thus 
enlarge the anterio-posterior dimensions of the cavity of 
the thorax ; its lateral dimensions are increased by the 
ribs rocking out at their angles, and the diaphragm 
likewise descends, and increases its depth. A vacuum 
now exists between the lungs and the pleura costalis, 
which permits the air to rush in at the larynx, and dis- 
tend the cells of the lungs. Inspiration beitlfr finish- 
ed, the cartilages, which, in the raising of the ribs, 
v/ere somewhat twisted, now regain their natural situa 



16 ANATOMY AND 

tion, and in so doing throw down the ribs; the dia- 
phragm also ascends, and expiration is thus effected. 

Q. Of how many bones is the shoulder composed ? 

A. Of two; the scapula and clavicle. 

Q. To what bone is the os humerus articulated ? 

A. It is articulated with the scapula, at its glenoid 
cavity. 

Q. Describe the scapula. 

A. The scapula is a triangular bone, situated at the 
upper and posterior part of the thorax. It has three 
margins, a spine, an acromion, and coracoid process, 
and an articular cavity for the head of the humerus. 

Q. How many bones compose the fore arm ? 

A. Two ; the ulna and radius. 

Q. By what bone are we supported when we rest on 
our elbow I 

A. On the ulna. 

Q. What process of the ulna forms the point of the 
elbow ? 

A. The olecranon. 

Q. What is the situation of the clavicle ? 

A. It is placed transversely, and somewhat oblique- 
ly, at the upper and anterior part of the thorax, be- 
tween the scapula and sternum ; it has in form a consi- 
derable resemblance to the italic./". 

Q Where is the ulna situated ? 

A. When the hand is supine, it is situated at ilie un- 
der, and inner part of the lore arm, between the hume- 
rus and carpus. 

Q. By what bone is the arm united to the thorax ? 

A. By the scapula. 

Q. Into how many parts is the hand divided ] 

A. Into the carpus, metacarpus, and fingers. 

Q. What bone is attached to the acromion scapula ? 

A. The clavicle. 

Q. Of how many bones does the metacarpus consist, 
and what is its situation ? 

\ . It consists of four bones, one supporting each fin- 



PHYSIOLOGY. 17 

ger ; it is situated immediately below the carpus, and 
forms the bony structure of the palm of the hand. 

Q. To which of the bonesof the forearm is the hand 
attached ? 

A. To the radius, which moves with it in the acts of 
pronation and supination. 

Q. How many bones enter into the formation of the 
carpus or wrist ? 

A. Eight ; the os scaphoides, os lunare, os cuneiforme, 
os orbiculare, os trapezium, os magnum, and os unci- 
forine. 

Q. What are the muscles that arise from the trunk, 
and are inserted into the scapula ? 

A. They are the trapezius, levator scapulae, pectora- 
l's minor, rhomboideus, serratus magnus, and subcla- 
vius. 

Q. What are the veins at the flexure of the arm ? 

A. The cephalic, on the radial side; the basilic, on 
the ulnar side j and between these the median cephalic 
and median basilic. 

Q. What muscles generally arise from the external 
condyle of the humerus ? 

A. The extensors and supinators of the hand. 

Q. What artery forms the superficial palmar arch 

A. Chiefly the ulnar artery. 

Q. What muscles arise from about the shoulder join!, 
and are inserted in the humerus ? 

A. The deltoides, coroco-brachiilis supra-spinatus, 
infraspinatus, teres minor, teres major, and sub- 
scapulari9. 

Q. What muscles principally arise from the inner 
condyle of the os humeri I 

A. The flexors and pronators of the band. 

Q. What tendon passes through the shoulder joint » 

A The long tendon of the biceps flexor cubiti. 

Q. Between what tendons does the radial artery lie 
at the wrist ? 

A. Between the tendons of the flexor carpi radialis 
and supinator longus. 

b2 



18 ANATOMY AND 

Q. What muscles are attached to the coracoid pro- 
cess of the scapula ! 

A. The coraco-brachialis, the pectoralis minor, and 
the short head of the biceps flexor cubiti. 

Q. Are the nerves of the arm derived from the brain 
or from the spinal marrow ? 

A. From the spinal marrow. 

Q. What forms the profundal palmar arch > 

A. Principally the radial artery. 

Q. How many muscles arise from the shoulder, and 
are inserted into the fore arm ? 

A. They are two in number; viz. the biceps flexor 
cubiti, and the long head of the triceps. 

Q. On which side of the tendon of the biceps flexor 
cubiti is the brachial artery situated, at the bend of the 
arm ? 

A. On the inner side. 

Q. What are the ligaments situated about the shoul- 
der joint ? 

A. First, the capsular ligament of the joint; second, 
the triangular ligament, which extends from the cora- 
coid to the acromion process ; and third, the coracoid 
and trapezius ligaments, which extend from the clavi- 
cle to the coracoid process of the scapula. 

Q. What are the muscles which arise from the arm, 
and are inserted into the fore arm ? 

A. The anconeus, the short heads of the triceps ex- 
tensor cubiti, the brachialis internus,the supinator radii 
longus, supinator radii brevis, and the pronator radii 
teres. 

Q. Where is the larynx situated ? 

A. It is situated at the upper and fore part of the 
neck, at the root of the tongue, constituting the upper 
part and entrance into the trachea. 

Q. What do you mean by the pharynx ? 

A. It is a membranous and muscular bag, expanded 
above, contracted below, and terminating in the oeso- 
phagus ; it is situated at the posterior part of the mouth 
and nares, between the Jaryns and cervical Yertebrx. 



PHYSIOLOGY. IV 

Q. Of how many cartilages does the larynx consist ! 

A. Of five ; vi7.. the thyroid, cricoid, the two aryte- 
noid, and the epiglottis. 

Q. What do you mean by the glottis ? 

A. It is the opening into the larynx, formed between 
two small ligaments, which proceed from the middle of 
the posterior side of the thyroid to the bases of the 
arytenoid cartilages. 

Q. Where is the 03 hyoides situated ? 

A. It is situated at the root of the tongue, between it 
and the larynx. In its form it somewhat resembles the 
Greek letter v. 

Q. What is the situation of the common carotid arte- 
ry in the neck ? 

A. It lies on the side of the trachea, between it and 
the internal jugular vein. 

Q. Where is the thyroid gland situated ? 

A. Upon the front of'the trachea, lying on the cricoid 
cartilage, and the cornua of the thyroid cartilage. 

Q. Of what is the tongue composed ? 

A. Of soft muscular libres, intermixed with a medu. 
»ary or fatty substance. 

Q. What is the situation of the par vagum in the 
neck ? 

A. It is situated between the carotid artery and the 
internal jugular vein. 

Q. By what glands is the saliva secreted ? 

A. By the parotid, the sub-maxillary, and the sub- 
lingual glands. 

Q, From how many sources does the tongue receive 
its nerves > 

A. From thee principal sources on each side ; viz. 
from the fifth, the eighth, and the ninth pair of nerves 
of the head. 

Q. Where are the ventricles of Morgagni situated : 

A. They are situated immediately within the glottis, 
and are formed by the lining membrane of the larynx 
dipping down between the upper and lower ligaments 
of the glottis on each side. 



20 ANATOMY AND 

Q. What is the situation of the sub-maxillary glands . 
A. They are situated on the inside of each angle ot 
the lower jaw, near the internal pterygoid muscles. 
Q. What are the muscles which form the tongue ? 
A. The upper and lateral parts of the tongue are 
composed of the stylo-glossi muscles ; its middle por- 
tion is formed of the linguales, the lower part is princi- 
pally formed of the genio-glossi, and the posterior part 
of the styloglossi muscles. 

Q. How many arteries has the thyroid gland ? 
A. Four ; viz" the two superior, and the two inferior 
thyroidal. 

Q. What is the excretory duct of the sub-maxillary 
gland called, and where does it open ? 

A. It is called the duct of Wharton; it passes be- 
tween the genio-glossus and mylo-hyoideus muscles, 
and opens on the side of the frxnum linguse. 
Q. What is the situation of the parotid glands ? 
A. They are situated, one on each side, between the 
external ear and the ramus and angle of the lower jaw, 
extending over some part of the masseter muscle. 

Q. Where are the arteries of the thyroid gland de- 
rived from ? 

A. The superior ones are given off by the right and 
left external carotid ,- the inferior, by the right and left 
subclavian. 

Q. What is the situation of the sublingual gland? 
A. It is situated between the genio glossus and mylo- 
hyoideus muscles, under the anterior part of the 
tongue; its ducts, which are several, open under the 
tongue. 

Q. Where does the excretory duct of the parotid 
gland open ? 

A. It passes obliquely over the masseter muscle, and 
perforates the cheek, opening into the mouth opposite 
the space between the second and third molar teeth. 
It is called the duct of Steno. 

Q. Of what bones does the pelvis consist ? 

\. It is formed posteriorly by the sacrum and 03 



PHYSIOLOGY. 21 

coccygis, and anteriorly and laterally by the ossa innu- 
minata. 

Q. How would you distinguish a male from a female 
pelvis ? 

A. In the female pelvis, the sacrum is shorter and 
broader than that of the male, the ilia are more ex- 
panded, and the tuberosities of the ischia are farther 
apart. The brim of the female pelvis is nearly of an 
oval shape, being wider from side to side than from the 
pubis to the sacrum ; whereas in man it is rounder, 
and every where of less diameter ; the sacrum is nar- 
rower, and the os coccygis more firmly connected. 

Q. Describe the sacrum. 

A. It is of a pyramidal form, with the basis upwards 
and the apex downwards; having an anterior or 
concave side, and a posterior or convex one, with two 
edges. It consists, in the foetus, of five portions ; the 
points of separation between which are marked by 
prominent lines in the adult. There are four pair of 
holes in the sacrum, anteriorly and posteriorly. 

Q. Into how many portions is each os innominatum 
divided ? 

A. Into three ; viz. the superior broad expanded 
part is called the os ilium ; the inferior part, the os 
ischium ; and the anterior narrow part, the pubis. 

Q. What are the ligaments of the pelvis ? 

A. 1st. Poupart's ligament, which arises from the 
superior anterior spinous process of the ilium, and is 
inserted into the angle of the pubis ; 2d, the annular li- 
gament, which surrounds the articulation of the ossa 
pubis ; 3d, the obturator ligament, closing up the fora- 
men thyroideum, excepting at the upper part, where a 
notch is left; 4th, the transverse ligaments, arising 
from the transverse processes of the three last lumbal 
vertebra:, and inserted into the back part of the ilium; 5th, 
the ilio-sacral ligament, arising from the posterior part 
of the ilium, and inserted into the back of the sacrum ; 
6th, the sacro-ischiatic ligament, arising from the is- 



22 ANATOMY AND 

chium, and inserted into the sacrum ; 7lh, the liga- 
menta vaga, which pass from the ilium to the sacrum. 
Q. Where is the tuberosity of the ischium situated ? 
A At the most inferior part of the os innominatum ; 
it is the part we rest upon when sitting. 

Q. What is meant by the brim of Die pelvis ? 

A. It is a ridge which extends, inside of the pelvis, 
from the symphysis pubis to the junction of the os inno- 
minatum with the sacrum, on a level with the upper 
margin of the pubis, and forms the line of division be- 
tween the pelvis and abdomen. 

Q. What are the connexions of the os sacrum ? 

A. It is connected laterally to the ossa innominata ; 
superiorly, to the last lumbar vertebra ; and inferiorly, 
to the coccygis. 

Q. What is the situation of the coccygis ? 

A It is attached to the lower part of the sacrum. 

Q. Describe the urinary bladder. 

A. It is a large membranous bag, somewhat of an 
oval form, which serves as a reservoir for the urine ; 
it is situated in the front of the pelvis, immediately be- 
hind the symphysis pubis, and before the rectum. 

Q. Of what parts do the male organs of generation 
eonsist ? 

A. Of the testicles, with the epididymis and vasa 
deferentia, contained in the scrotum ; of the vesicula:, 
seminales, prostate gland, Cowper's glands, caput 
galinaginis, and the penis. 

Q. What forms the scrotum ? 

A. It is formed by a continuation of the common in- 
teguments. 

Q. How many coats has each testide ? 

A Two ; the tunica albuginea, which firmly invests 
the testicle ; and the tunica vaginalis which loosely en- 
velops it, as the pericardium does the heart. 

Q. Of how many parts does the penis consist ? 

A. Of the corpora cavernosa, corpus spongiosum, 
the urethra, and glans penis. 

Q. What are the female organs of generation ? 



PHYSIOLOGV. 23 

A. Internally, they are the uterus with its appenda- 
ges, the ovaria, fallopian tubes, and vagina ; and exter- 
nally, the mons veneris, labia pudetidi, nymphse, and 
clitoris. 

Q. Where is the prostate gland situated ? 

A. It lies directly under the symphysis pubis, em- 
bracing the neck of the bladder, and resting upon the 
rectum. 

Q. Where are Cowper's glands to be found ? 

A. They are situated near the bulb of the urethra, 
before the prostate gland. 

Q. Describe the uterus. 

A. It is a spongy hollow viscus, of a pear shape, si- 
tuated in the pelvis of the female, between the rectum 
and the urinary bladder ; it is divided into a fundus, 
cervex, and orifice,or os tincx, and has four ligaments. 

Q. How many openings are there into the bladder ? 

A. Three ; one inferior, which is the beginning of the 
urethra, surrounded by the neck of the bladder; and 
two posterior, which are the terminations of the ure- 
ters. 

Q. Through what tube-does the ovum pass into the 
uterus from the ovaria, after conception ? 

A. Through the fallopian tubes. 

Q. What is the excretory duct of the testicle called I 

A. The vas deferens. 

Q. At what part is the urethra most dilated ? 

A. At that part which is surrounded by the pros- 
tate gland. 

Q. What do you mean by the clitoris ? 

A. It is a firm projecting body, about an inch in length, 
situated immediately under the superior commissure of 
the labia pudendi, consisting, like the penis, of two cor- 
pora cavernosa, forming a glans anteriorly, and divid- 
ing posteriorly into two crura; like the penis it is ca- 
pable of erection. 

Q. In what manner do the ureters enter the bladder! 
A. They pass obliquely through its coats, and open 



24 ANATOMY AND 

about an inch and a half from each other, and the same 
distance from the orifice of the urethra. 

Q. What do you mean by the spermatic chord ? 
A. It is a chord composed of the trunks of the dif- 
ferent vessels belonging to the testicle ; it is invested 
by the same process of the peritoneum, which forms 
the tunica vaginalis testis, and is covered by the ere- 
master muscle, and extends from the abdominal ring 
to the body of the testis. 

Q. What is the length of the female urethra ? 
A. It is about an inch to an inch and a half in 
length. 

Q. Where are the testicles situated in the fetus } 
A. Previously to the sixth month they are situated 
in the abdomen, at the lower part of the kidneys, and 
receive a covering from the peritonaeum. 

Q. Where do the corpora cavernosa penis arise ? 
A. They arise from the edge of the ramus of the 
ischium and pubis. 

Q. What do you mean by the veru montanum, or 
eaput-gallinaginus ? 

A. I mean a small oblong oval eminence, situated 
immediately within the prostate gland, at the under 
part of the urethra. 

Q. How many openings are there into the uterus ? 
A. Three; the orifices of the two fallopian tubes at 
the angles of its fundus, and the os uteri at its neck. 

Q. How many dilatations are there in the male 
urethra ? 

A. Generally three ; one at the point of the glans 
penis, another at the bulb of the urethra, and a third 
within the prostate gland. 

Q. How many coats has the bladder ? 
A. It has a muscular, a nervous or cellular, and a 
villous or mucous coat ; and its fundus, sides, and back 
part, to a little way within the termination of the ure- 
ters, receive a covering from the peritonxum. 

Q. What do you mean by the vesiculae seminales ? 
A. I mean two small oblong membranous bodies, 



PHYSIOLOGY. 25 

situated obliquely at the lower and under part of the 
bladder and before the rectum, near each other before, 
but diverging posteriorly ; they are formed by the con- 
volution of one tube, whose doublings are so closely 
connected together, that internally the vesiculx seem 
composed of cells. 

Q. Where do we find the orifice of the urethra in fe- 
males ? 

A. It is situated between the nympha;, about an inch 
below the clitoris, and just above the orifice of the va- 
gina ; the orifice is slightly prominent. 

Q; How long is the female urethra ? 

A. It is about an inch in length ; it has no prostate 
gland. 

Q, What is meant by menstruation ? 

A. It is the discharge of a sanguineous fluid from 
the uterus, which occurs every month in the healthy 
iemale. 

Q. At what period of life does menstruation exist ? 

A. From the fourteenth to the forty-fifth year, gene 
rally speaking. 

Q. How is the cavity of the abdomen formed ? 

A. It is formed above, by the diaphragm and the 
margin of the thorax j behind, by the lumbar vertebrae ; 
below, by the pelvis ; and anteriorly and laterally, by 
the abdominal muscles. 

Q. How many abdominal muscles are there ? 

A. There are five pair ; viz. the obliquus externus 
abdominis descendens; the obliquus internus ascen- 
dens ; the transversalis abdominis ; the rectus abdo- 
minis ; and the pyramidalis. 

Q. What is the membrane called, that lines the ca- 
vity and coveu^the viscera of the abdomen ? 

A. The peflftjnaeum. 

Q. How would you distinguish the small from the 
large intestines ? 

A. The large intestines have three longitudinal 
bands, running on their surface ; they are lobulated, 
and have portions of fat adhering to them, called ap- 
C 



26 ANATOMY AND 

pendicles epiploic*, which circumstances are absent 
in the small intestines. In the small intestines exist 
the valvule conniventes, but not in the large. 

Q. How many openings are there in the stomach ? 

A. Two ; the cardia, which is situated at the supe- 
rior part, at a little distance from the great extremity, 
and receives the oesophagus ; and the pylorus, which 
is situated at the termination of the lesser extremity, 
and opens into the intestines. 

Q, Describe the liver. 

A. The liver is the largest of the abdominal viscera ; 
it is placed in the right hypochondriac region, and ex- 
tends partly into the epigastric region. It is divided 
into three lobes, is suspended by five ligaments, which 
are productions of the peritoneum, and is composed of 
arteries, veins, nerves, absorbents, excretory ducts, 
cellular membrane, &.C., and is invested by the perito- 
naeum. 

Q. What is situated between the two lamina: of the 
mesentery ? 

A. The laeteals, arteries, lymphatics, veins, nerves, 
and glands of the intestines. 

Q. Describe the stomach. 

A. The stomach is a membranous bag, somewhat 
resembling in form the bagpipe, placed in the left hy- 
pochondriac and epigastric regions. It is composed 
of three coats, and has a superior orifice, called cardia, 
and an inferior, called pylorus ; a greater and lesser 
curvature, and two surfaces, an anterior and posterior. 

Q. What is the situation of the gall-bladder ? 

A. It is situated in the anterior part of the inferior 
surface of the great lobe of the liver. 

Q. What is the course of the bile through and from 
the liver ? 

A. The bile, secreted by the extremities of the vena 
ports, in the acini of the liver, passes through the pori 
baliarii and branches of the hepatic duct ; by this duct 
it is conveyed to the ductus communis coledochus; 
from whence it passes, through the cystic duct, into 



PHYSIOLOGY. 27 

the gall-bladder; when it passes into the intestines, it 
returns, through the cystic duct, and. mixing ; n the 
ductus communis with fresh bile from the hepatic 
duct, is conveyed into the duodenum. 

Q. What is the first artery given off by the aorta af- 
ter passing into the abdomen ? 

A. The celiac. 

Q. What viscera ate attached to the great curvature 
of the stomach ? 

A. The great omentum, the spleen, and the trans- 
verse arch of the colon. 

Q. What are the blood-vessels of the liver? 

A. They are, 1st, the hepatic artery, or nutrient ves- 
sel of the liver; 2d, the vena portx, from the blood of 
which the bile is secreted ; and 3d, the hepatic veins, 
by which the blood of the hepatic artery and of the 
vena portae is returned into the cava. 

Q. What is the situation and nature of the pancreas? 

A. It is situated at the back part of the epigastric re- 
gion, transversely under the stomach and before the 
spine, crura of the diaphragm, and the aorta or vena 
cava. K is a glandular body, of an oblong flat form, 
and of a greyish white colour ; it secretes a fluid re- 
sembling the saliva. 

Q. How many vessels go to the stomach, and from 
whence do they arise ? 

A. There are three principal branches ; viz the su- 
perior coronary, which arises from the cadiac ; the 
light gastroepiploic, which is a branch of the hepatic, 
and the left gastro epiploic, which is a branch of the 
splenic. Besides this, several small branches pass front 
the splenic to the greater extremity of the stomach, 
and are called vasa brevia. 

Q. Describe the situation and course of the colon. 

A. The colon commences at the coecum, in the right 
iliac region, ascends in the rightlumbarregion, over the 
kidney of that side, to the liver ; it now crosses the ab- 
domen, under the liver and stomach, forming its gnat 
jircb, and passes to the left side, where it descends, by 



^6 ANATOMY AND 

:i sigmoid flexure, to the pelvis, and terminates in front 
of the spine, in the rectum. 

Q. What difference is there between the situation of 
the right and left kidneys ? 

A. The right kidney is much lower than the left, oc- 
casioned by the liver occupying so much space. 

Q. What are the vessels surrounded by the capsule 
of Glysson ? 

A. They are the vena portx, the hepatic artery and 
veins, the excretory ducts of the liver, and some ab- 
sorbents. 

Q. What do you mean by the spleen ; 

A. It is a soft, sponge-like, fleshy mass, of a purple 
colour, and varying in size in different individuals ; it is 
situated deep in the left hypochondrium, at the large- 
extremity of the stomach ; its use is unknown. 

Q. Has the kidney a peritoneal coat ? 

A. No ; it has no peritoneal coat, but is every where 
surrounded by a coat of its own, which consists of two 
laminje. 

Q. What is the name of the ganglion in the abdomen, 
from which the nerves of most of the abdominal viscera 
are derived ? 

A. It is the semilunar ganglion, and is formed by the 
greater splanchnic branch of the sympathetic 

Q. What forms the capsule of Glysson ? 

A. It is a reflection of the peritonxum, investing the 
vessels, &c. of the liver, just before they enter that 
viscus. 

Q. How many coats have the stomach and the intes- 
tines r 

A. Four; viz. an external or peritoneal, next a mus- 
cular, then a cellular or nervous, and internally a vil- 
lous or mucous coat. 

Q- What is the excretory duct of the kidney called ? 

A. The ureter. 

Q. What is the situation of the mesentery ? 

A. It commences at the last incurvation of the duo- 
uenum, and passes obliquely from left to right along 



V1IYSI0L0GY. 29 

the vertebrae of the loins. To its exterior edge are at- 
tached the small intestines. 

Q. Where does the excretory duct of the pancreas 
terminate ? 

A. tn the duodenum, in common with the ductus 
communis coledochus of the liver. 

Q, What is the omentum ? 

A. It is a large duplicative of the peritoneum, which 
is attached to the greater curvature oftlie stomach, 
and descends loosely in front of the intestines, to below 
the umbilicus. 

Q. What is the office of the stomach ? 

A- It is to contain the food until dissolved by the 
gastric juice, which is a peculiar fluid secreted by the 
arteries on its internal surface. 

(>. What are the ducts that enter the duodenum ? 

A. The ductus communis coledochus, and the duc- 
tus pancreaticus ; they in general enter by one orifice. 

Q, What do you mean by the renal glands, or capsula 
reuales ? 

A. They are two small oblong and flat bodies, of 'i 
dark yellow colour, situated immediately above, the kid- 
, on w hich they n »t. 

Q. In what intestines are the valvule conniventes 

i.jliml ' 

A. In the small intestines, but chiefly in the duode- 
num and jejunum. 

<l What forms the linea alba ? 

A. The junction of the flat tendons of the abdominal 
muscles, without the intervention of any muscular 
fibres. 

Q. What are the arteries, which supply the kidneys, 
railed r 

V Thcemulgents, or renal arteries. 

Q. Where is the diaphragm situated ? 

A. Between the thorax and abdomen, forming a 
vaulted arch or septum, attached to the borders of the 
lowermost ribs. 

c2 



.» 



30 ANATOMY AND 

Q. How is the sheath formed, in which the rectir 
abdominis muscle is contained? 

A. The tendon of the internal oblique divides into 
two layers, the anterior of which joins the tendon of 
the external oblique, and passes in front of the rectus, 
and is inserted in the linea alba; the posterior layer 
joins the tendon of the transversalis, and passes behind 
the rectus, from the insertion of that muscle until about 
half way between the umbilicus and pubis ; below this, 
only a few fibres of the posterior layer passes behind 
the rectus, the principal part being found in front of 
the muscle. 

Q. What are the excretory ducts of the liver called? 

A. Pori biliarii. 

Q. On which side of the aorta is the emulgent artery 
the longest ? 

A. On the right j this arises from the vena cava be- 
ing placed upon that side, and the artery having to pass 
behind that vessel. 

Q. What parts does the cxliac artery supply ? 

A. The stomach, the liver, and the spleen. 

<-i. From whence does the stomach derive its nerves ? 

A. From the eighth pair, and the great sympathetic. 

Q. What do you mean by the foramen of Winslow ? 

A. It is a semilunar opening, situated in the omen- 
Uim, on the right side, below Glysson's capsule; by 
which the cavity of the omentum communicates with 
the cavity of the abdomen. 

Q. What separates the canal of the small, from that 
of the large intestines ? 

A. A valvular structure, denominated the valve of 
the colon, or the valve of Tulpius. 

Q. Where do the lacteals terminate ? 

A. Into the receptaculum chyli. 

(i. Where is the receptaculum chyli situated ? 

A. It is situated on the body of the first lumbar veri 
tebra, behind the right cius of the diaphragm, and 
above the right emulgent artery. 



PHYSIOLOGY. 31 

CI. In what manner does an enlargement of the me- 
senteric glands cause atrophy } 

A. By obliterating the cavity of the lacteals which 
pass through them, and thus obstructing the passage 
of the chyle to the thoracic duct. 

Q. What vessels form the vena porta: ? 

A. The superior and inferior mesenteric, and the 
splenic. 

U_. What is the course of the thoracic duct ? 

A, After passing between the crura of the diaphragm, 
it ascends on the right side of the aorta, between that 
vessel and the vena azygos, to the fifth dorsal vertebra, 
when it passes behind the oesophagus and the curve of 
the aorta, and ascends, on the left side of the oesopha- 
gus, to the first or second dorsal vertebra, where, leav- 
ing the carotid, it makes a semicircular turn, and ter- 
minates in the left subclavian vein. 

Q. To what bone is the os femora articulated r 

A. It is articulated to the acetabulum, or cup-like 
cavity of the os innominatum. 

Q. Upon what bone does the leg rest ? 

A. Upon the astragalus, to which the tibia is articu- 
lated. 

Q. Where is the trochanter major situated ? 

A. It forms the great projection at the superior and 
anterior part of the thigh bone. 

Q. Of how many bones does the leg consist ? 

A. Of two ; the tibia and fibula. 

Q What bones form the hip joint ? 

A. The roundhead of the os femoris, and the aceta- 
bulum of the os innominatum. 

<■!. What forms the crural nerve I 

A. The union of the three or four superior lumbar 
nerves. 

Q. How many muscles arise from the os ilium, and 
are inserted into the os femoris ? 

A. Five ; viz. the three glutse.i, the iliacus internus, 
and the tensor vagina femoris. 

Q. What do you mean by bursjc mucosre ? 



ANATOMY AND 

A. They are mucous bags, whose internal surfaces 
are lubricated by a synovial fluid, interposed between 
tendons which nil) against each other, or where they 
play on the surface of bones, or joints, and also, be- 
tween the integuments and certain prominent points of 
bones, viz. at the knee, elbow, and knuckles. 

Q. On what bone is the Imea aspera situated ? 

A. On the back part of the os femotfSs. 

Q. What is the situation and form of the tibia ? 

A. It is situated on the inner side of the leg; it is ir- 
regularly triangular, and is larger above than below. 

Q. AA'hat forms the outer ancle ? 

A. The lower end of the fibula, 

Q, In standing, what prevents the leg from falling 
forward ? 

A. The soleus, or gastrocnemius internus, muscle. 

Q. What are the ligaments concerned in the hip 
joint ? 

A. They are, 1st, the capsular ligament, arising from 
the margin of the acetabulum, and inserted in the os 
femoris, round the root of its neck j and 2d, the 
round ligament, arising from a small depression in the 
head of the os femoris, and inserted in the middle of 
the acetabulum. 

Q. What muscles arise from the ischium and pubis 
to be inserted into the thigh ? 

A- From the pubis, arise the pectinalis, obturator 
externus, and the three abductors of the thigh ; from 
the ischium, the geminii and quadratus femoris. 

Q AVhat bone forms the heel ? 

A. The os calcis. 

Q. AVhat is the situation of the popliteal artery ? 

A. It is situated in the ham, between the condyles of 
the os femoris and the heads of the external gastroc- 
nemius muscle. 

Q. What is the name of the tendon formed by the 
union of the tendons of the external gastrocnemius and 
soleus muscles ? 

A. The tendo achillis. 



PHYSIOLOGY. 

'I. What forms the inner ancle ? 

A A process from the lower extremity of the tibia. 

Q. What muscles are concerned in burning out the 
toes ? 

A. The obturator externus and interims, the gemini, 
the pyriformis, the qtiadratus femoris, and the giutxi. 

Q. What are the ligaments which connect the os fe- 
moris with the leg ? 

A They are, 1st, the capsular ligament, surround- 
ing the joint ; 2d, the popliteal, arising from the outer 
condyle of the femur, and expanding on the internal 
side of the joint; 3d, the external and internal lateral, 
arising from the condyles of the femur, and inserted in 
the upper part of the leg; and 4th, the crucial liga- 
ments, which arise from the notch between the con- 
dyles of the femur, and are inserted in the rough ridge 
on the top of the tibia; these ligaments cross each other 
<n the form of the letter X. 

Q. What is the situation of the great sciatic nerve in 
the thigh ? 

A. It is situated at the back part of the thigh, de- 
scending from the pelvis, first upon the long flexors and 
adductor magnus, and then between the latter and the 
os femoris, to the ham, where it obtains the name of 
popliteus. 

Q. Of how many bones is the metatarsus composed ? 

A. Of five; one supporting each toe. 

ti. What are the muscles which are inserted into the 
os calcis ? 

A. They are the gastrocnemei and pi an tar ia, 

Q. What tendon does the femoral artery perforate in 
passing to the back of the thigh, in order to get into 
the ham ? 

A. It perforates the tendon of the adductor magnus, 
at the distance of about one-third of the length of the 
bone from its lower extremity. 

Q. How many muscles are inserted in the leg ? 

A. Eleven; six of which, viz. the rectus, sartorius, 
gracilis, semitendinosus, semimembranosus, and long- 



34 ANATOMY AND 

head of the biceps, arise from the pelvis ; and rive, -, , 
the cruralis, the two vasli, t lie short head of the biceps, 
and the poplittus, arise from the os ft-moris. 

<J. How is the aci of waiting performed ? 

A. let, the weight of the "body is to be removed from 
oft' the leg which is to be advanced, this is done by the 
action of the pcronei, vastus exttrnus, gluteus medi- 
ns, &c of the opposite side ; 2d, the leg is advanced, 
h\ tiie action of the iliac us intermis and psnz muscles; 
3d, the weight of the whole body is now to be brought 
over the advanced leg, and this is effected by the ac- 
tion of the peroneus longus, the tibialis anticus, the rec- 
tus femoris, and the psoje and iliacus muscles of the ad- 
vanced leg ; when these have thrown the body as far for- 
wards as possible, the gastrocnemei and the long flexor 
of the big toe of the hind leg act, and forming the toot 
into a lever, push the body over the advanced leg ; 4th, 
the hind leg is advanced by the psose and iliacus inter- 
nus of that side, and the same motions are again re- 
pealed. There is another mode of walking, which is 
performed merely by the twisting of the pelvis on the 
spine. 

Qt. Under what muscle is the femoral artery situat- 
ed, in the middle of the thigh ? 

A. Under the Sartorius. 

Q. How many muscles are inserted into the patella ' 

A. Four; viz. the rectus femoris, the two rasti, and 
the crureuss. 

Q. What is the course of the anterior tibial artery ? 

A. After coming off' from the popliteal, it passes 
through a large perforation in the interosseus ligament, 
to reach the fore part of the leg; the artery then 
passes down close to the interosseus ligament, between 
the tibialis anticus and extensor proprins pollicis ; be- 
low the middle of the leg, it leaves the interosseus liga- 
ment, and crosses under the tendon of the extensor 
propiius pollicis, and passes down between that tendon 
and the first tendon of the extensor longus digitorum ; 
at the ancle it passes over the front of the tibia, over 



PHYSIOLOGY. j5 

the astragalus, os orbiculare, and os cuneiforme ; cross- 
ing under that tendon ofthe extensor brevis digitoTiim, 
which £oes to the £ivat toe, it arrives between ihe two 
first metatarsal bones, and then plunges down into the 
sole ofthe toot to join the plantaratch. 

Q. What parts of the body are free from adipose 
structure! 1 

A. The integuments of the penis, of the scrotum, 
and of the eye-lids. 

CA. What is the contraction oftne heart called ? 

A. It is called its systole. 

Q. Where is the Eustachean tube situated ? 

A. It passes from the cavity of the tympanum ob- 
liquely forward and inward, and opens in the fauces 
behind the posterior nares. 

CI. What are the differences between the adult and 
foetal heart. ? 

A. In the fcetal heart an opening exists between the 
auricles, in the septum auricularum, called the. foramen 
ovale; this is closed in the adult heart. An artery also 
passes from the pulmonary artery obliquely lo the as- 
cending aorta in the foetus, this is called the canalis ar- 
teriosus, and becomes converted into an impervious 
chord in the adult. 

Q. Where is the external cutaneous nerve situated at 
the bend of the elbow ? 

A. It is situated under the cephalic, and the median 
cephalic veins. 

Q. Mow are arteries distinguished from veins ? 

A. By the coats of the former being whiter and more 
dense, and also more elastic ; their apertures gape in 
the living body, and they pulsate. The arteries and 
veins ofthe lower extremities are very similar in regard 
to the thickness of their coats. 

Q. What is the tunica conjunctiva ? 

A. It i> a reflection of the inner membrane of the eye- 
lids, over the surface of the eyes. 

Q., What is meant by the diastole of the heart ? 

A. Its dilatation. 



36 AXATOM\ AN1> 

Q. Where rue the va6a vorticosa situated ' 

A. On the choroid coat of the eye; they are formed 
by a contortion of the vessels of that membrane. 

' Q. What is the situation of the torcular of Hero 
philus ' 

A. It is those veins of the brain which are situated 
at the junction of the fal* and tentorium, and receive 
the blood from the inferior longitudinal sinus and vena 
magna galeni. 

<i. What parts compose the lacrymal apparatus ? 

A. The lacrymal gland, the caruncula lacrymalis, 
plica semilunaris, puncla lacrymalia, lacrymal sac, and 
the ductus ad nasum. 

Q.. What is the situation of the posterior tibial ar- 
tery ? 

A. It is situated at the back of the leg, between the 
soleus muscle and the deep seated flexors of the toes. 

Q. How many coats lias the eye ? 

A. Six ; viz. the tunica conjunctiva, tunica sclerotica, 
cornea, tunica choroides, iris, and retina. 

Q. What nerves form the commencement of the great 
sympathetic ? 

A. A branch of the sixth pair, and a recurrent 
twig from the second branch of the fifth pair. 

Q Where is the ■ igmentum nigrum of the eye si- 
tuated ? 

A. Upon the posterior part of the iris, and uponjthe 
Surface of the tunica choroides. 

Q. How many chambers has the eye ? 

A Two ; an anterior and a posterior. 

Q. What separates the two chambers ? 

A. The iris forms a partial septum between them. 

Q. What arteries are given off at the arch of the 
aorta ? 

A. Three branches ; viz. the arteria innominata, the 
left carotid, and left subclavian. 

Q What forms the chorda tympani ? 

A. It is formed by a reflected twig of the portia dura, 
and passes between the long process of the malleus 
and the incus, and over themembrana tympani. 



PHYSIOLOGY. 37 

ti. How many nerves go to the eye ? 

A. Five pair; viz.. the second, third, fourth, sixth, 
and first branch of the fifth. 

Q. What forms the common integuments ? 

A The cuticle, rete mucosum, cutis, and cellular 
membrane. 

Q. What are the external parts of the eye ? 

A. They are the supercilia, or eye-brows ; the eye- 
lids, or palpebral, with their tarsi and cilia, or eye- 
lashes. 

Q. Where is the lachrymal sac situated ? 

A. At the inferior part of the inner angle of the eye, 
and the superior part of the lachrymal groove, in a de- 
pression of the os unguis, and behind the tendon of the 
orbicularis palpebrs. 

Q Of how many coats is the membrana tympanum 
composed ? 

A Of three ; viz. the lining membrane of the tym- 
panum, and the cutis and cuticle. 

Q. What forms the phrenic nerve ? 

A. It is formed by the third and fourth cervical 
nerves, and also receives a filament from the second. 

Q. What is the true organ of vision ? 

A. The retina. 

Q. What is the general division of the internal ear ? 

A. It is divided into the cavity of the tympanum, 
and of the labyrinth, which latter consists of the coch- 
lea, vestibulum, and semicircular canals. 

Q. How do arteries terminate ? 

A. They terminate either in veins, in secreting ex- 
tremities, in cells, as in the penis, &c, in glands, or by 
anastomoses. 

Q. What are the branches of the fifth pair of nerves? 

A. The principal branches, of the fifth pair of nerves 
are, 1st, the ophthalmic; 2d, the superior maxillary; 
and 3d, the inferior maxillary. The ophthalmic branch 
passes through the foramen lacerum of the sphenoid 
bone, and sends off, 1st, a frontal branch, through the 
superciliary notch to the forehead ; 2d, a nasal branch, 
I) 



38 vNATOMi, 8sc 

towards the inner cantbus, to the lachrymal sac, which 
also sends branches through the internal foramina; 
3d, a lachrymal branch to the lachrymal gland. The 
superior maxillary branch sends off, 1st, the pterygoid 
branch, one twig of which passes in at the vidian fora- 
men to join the portio dura, and another joins a portion 
of the sixth pair to form the sympathetic; 2d, the 
spheno palatino to the nose, through the foramen of that 
name ; 3d, the palatine down through the palatine fora- 
men to the mouth ; 4th, the infra orbitar through the ca- 
nal of that name, to supply the upper teeth and lip, 8tc. 
The. inferior maxillary sends off, 1st, a. temporal branch ; 
2d, a branch to the cheek ; a lingual branch, which is 
the true gustatory nerve ; 4th, a dental branch, which 
enters the canal of the lower jaw, supplies the teeth, 
and finally passes out at the mental foramen to the 
chin. 

Q. Where is the lachrymal gland situated ? 

A. In a depression in the orbitar plate of the os fron- 
tis, somewhat above the external angular process of 
that bone. 

Q. Upon what vertebra is rotation of the head 
performed ? 

A. Upon the second vertebra, by the interposition of 
the atlas. 

Q What are the branches of the subclavian artery ? 

A. They are six in number; viz. the internal mam- 
mary, the inferior thyroid, the superior intercostals, the 
vertebral, and the cervicalis profunda and superficialis. 

Q. What parts of the body do the internal and ex- 
ternal carotids supply ? 

A The external carotid supplies the face and exter- 
nal parts of the head; the internal supplies the brain. 



SURGERY. 



SECTION II. 

Examinations in Surgery. 

Question. What do you mean by a compound frac- 
ture ? 

Answer. A fracture of the bone, complicated with 
an external wound of the soft parts communicating 
with the cavity of the fracture. 

Q. What is particularly to be attended to during the 
healing of ulcers resulting from burns ? 

A. To prevent, by the interposition of dressings, Sec. 
any unnatural adhesion of contiguous parts, and, by 
bandages and splints, to preserve the parts in a proper 
position, in order to prevent any deformity from the 
contraction to which the cicatrices are liable. 

Q. In what does a contused differ from an incised 
wound ? 

A. In an incised wound there is merely a solution of 
continuity in the part, whereas, in the contused wound, 
besides this solution of continuity, there is a bruising 
of the adjacent flesh. 

Q. How would you treat a contused wound ? 

A. After removing the extraneous matter, a poultice 
is to be applied until the dead parts separate, and when 
suppuration and granulation come on, the edges of the 
wound are to be drawn together, and retained so by 
the adhesive strips j should inflammation arise to any 
extent, bleeding will be proper. 

(1. Is the bleeding most profuse in an incised or con 
'used wound 3 



40 SURGERY. 

A. In the incised : in the contused wound, tl.e vet 
sels being injured for some distance from their divided 
edges, their power of circulating the blood is diminish- 
ed. The blood likewise being prevented from escap- 
ing readily, externally, is extravasated in the cellular 
membrane, making lateral pressure, and in a great 
measure closing the mouth of the arteries. Dr. Physick 
is of opinion also, that the blood more readily coagu- 
lates in the contused wound, which forms another bar- 
rier to the occurrence of hacmorrhagy to any extent in 
them. 

Q. How is an incised wound to be treated ? 

A. After commanding the haemorrhage, by pressure 
or by the ligature, according as a greater or less artery 
is wounded, all extraneous substances, the clotted 
blood, 8cc are to be removed, and the edges arc to be 
drawn in contact, and kept so by adhesive strips, aided 
by bandages, and a proper position of the part 

Q.. What is the proper treatment for a burn ? 

A. In cases of superficial burns, the application of 
cold water or vinegar to the injured part is to be pre- 
ferred. But when the burn is extensive, and the part 
has been killed by the fire, the best application appears 
to be the basilicon ointment, thinned with spirits of tur- 
pentine being careful in the application to confine it 
solely to the burnt surface, and not to permit it to come 
in contact with the sound skin. If fever arises to any 
extent, it is to be treated on the evacuating plan. If 
debility comes on, cordial remedies must be adminis- 
tered. 

Q. What are the symptoms of an inflamed ulcer ? 

A. A ragged elevated edge, redness and spelling of 
the surrounding parts, the blood quickly reluming 
when pressed out by the finger. There is a thin se- 
rous discharge, very great sensibility of the ulcer, and 
occasionally excessive, though not constant, pain. 

Q. What is the treatment proper for an inflamed 
ulcer ? 

A. Locally, a common poultice of bread and milk is 



SURGERY. 41 

the best application. The patient is to be confined to 
a horizontal position and a low diet ; purging, and oc- 
casionally blood-letting, will be proper 

Q. What is the process by which nature arrests the 
hemorrhage from a bleeding artery ? 

A. It" the artery be divided, it immediately retracts 
within its sheath and slightly contracts, at its wounded 
extremity, a portion of blood is effused between the ar- 
tery and its sheath, and also before the mouth of the 
artery, which blood forms an external coagulum ; an- 
other coagulum also is formed within the artery, and 
extends to the next collateral branch. Inflammation of 
the artery takes place, and coagulable lymph is effus- 
ed between the two coagula which unite them toge- 
ther, and adheres also all around to the inner coa> of 
the artery, and thus seals up its divided extremity. 
The cavity of that portion of the vessel between the 
wounded extremity and the next collateral branch, be- 
comes gradually obliterated, and the artery is convert- 
ed into* a ligamentous chord. When an artery is only 
punctured, a layer of coagulated blood is formed be- 
tween the artery and its sheath, which is somewhat 
thicker, directly over the punctured orifice; this last is 
finally closed by the process of inflammation. 

Q. What takes place in case an artery is wounded 
immediately in the vicinity of a collateral branch ? 

A. The external coagulum is formed as above, but 
there is no internal coagulum. 

Q. What are the symptoms of a dislocation of the 
thigh upwards and backwards ? 

A. The limb is shortened, the toes are turned in- 
wards and cannot be turned out, nor can the natural 
length 6e restored to the limb without reducing the 
dislocation 

Q. What is the difference between true and false 
aneu ism ? 

A. True aneurism consis's in a morbid dilatation of 
an arterv ; spurious aneurism is occa-ioned by the rup- 
ture or wound of an artery producing in the adjoining 



42 SURGERV 

cellular membrane a cavily or sac containing arterial 
blood. 

Q. Where is the operation For popliteal aneurism 
performed ? 

A. About the middle of the thigh, over the inner 
edge of the snrtorius muscle. 

Q. If in a lacerated wound a portion of the integu- 
ments, &c. were torn oft' to some extent, but still ad- 
hering by one extremity, would you remove this flap 3 

A. No; the flap should be laid loosely on the part 
from which it was torn, and retained in its place by a 
soft compress and bandage, if the edges be drawn ac- 
curately in contact, and retained thus by adhesive plas- 
ter, when inflammation and swelling' come on, the 
parts will be put on the stretch, the circulation through 
them impeded, and the whole will slough oil'. 

Q. How are wounds of the throat to be treated ? 

A. Superficial wounds ate to be treated in the sam?. 
manner as similar species of wounds in other parts of 
the body ; but when the trachea, &c are cut through, 
after securing the blood vessels by ligatures, we are to 
bring the edges of the wound as nearly in contact as 
possible, by bending the chin down upon the breast, 
and preserving it in that position by bandages, and pil- 
lows placed behind the head. All sutures, 8cc. are 
useless, or even mischievous. If the oesophagus be 
wounded, the patient may be nourished through a large 
catheter introduced into the stomach. 

Q. How would you treat a punctured wound ? 

A If a large artery be wounded, and continue bleed- 
ing, the wound must be dilated with a probe and scal- 
pel, and the vessel secured by a ligature. If there be 
no considerable artery wounded, any extraneous sub- 
stances that can be easily removed should be taken 
away, and a soft poultice applied. The symptoms and 
progress of the wound should be carefully watched, 
particularly in hot weather. 

Q. What is to be apprehended in cases of punctured 
wounds ? 



SURGERY. 43 

A. i Tetanus is a verv frequent consequence of these 
wounds in warm weather. 

Q.. How should the wound be treated in order to 
prevent this occurrence ? 

A. Uy dilating it with a scalpel, and inducing in- 
flammation in it by stimulating applications, as the oil 
ot 'turpentine, a sinapism, 8tc and allowing rather a ge- 
nerous diet. 

Q By what process is a fracture healed ? 

A. In the simple fracture, the b'ood effused between 
the fractured extremities of the bone becomes vascular, 
and in time is gradually converted into cartilage, and 
finally into bone. In the compound fracture this blood , 
is lost, and the re-union is effected by inflammation 
and granulation. 

Q. What is an abscess ? 

A. It is a circumscribed cavity containing pus. 

Q. What confines the pus to one particular spot, 
constituting an abscess ? 

A. Coagulable lymph is thrown out, which aggluti- 
nates together the cells of the cellular membrane, and 
thus prevents the pus from passing along these cells 
into the neighbouring parts. 

Q. What is the proper treatment for a sprain ? 

A. As soon after the occurrence of the accident as 
possible cold water should be poured upon the part, 
and afterwards it should be wrapped in cloths wet with 
cold vinegar or brandy, and kept in a state of perfect 
rest. As the application of cold water might be pro- 
ductive of bad effects in females at or about the period 
of menstruation, the application of the brandy or vi- 
negar should be resorted to at once. IF inflammation 
occur, this is to be counteracted by leeches and the 
general depleting plan, according to the urgency of the 
symptoms. 

Q. How does a ligature effect a permanent stoppage 
of hemorrhage from a divided artery ? 

A. By the ligature the inner coats of the artery are 
divided and kept in close contact, and are finally united 



SURGERY. 

by the process of inflammation, &c; a coagulum also 
forms within the artery, obliterating its cavity, unless 
the vessel be tied near the passing off of a collateral 
branch, in which case no coagulum exists. 

Q. How would you treat a wound occasioned by the 
bite of a rabid animal ? 

A. After carefully washing the wound with soap and 
water, I would completely extirpate with the knife 
every part with which the animal's tooth had come in 
contact ; and lest the scalpel should convey the poison 
to the newly divided parts, I would change it after each 
incision. The patient is also to be stripped, previous to 
the operation, of all the clothing he had on at the time 
of receiving the bite, for fear that they might have upon 
them a portion of the saliva of the animal, which might 
again come in contact with the wound. 

Q. What symptoms distinguish erysipelas from con*, 
mon phlegmonous inflammation ? 

A. In the erysipelas, the colour of the part is of a 
bright scarlet ; in the phlegmonous, of a darker red. 
In phlegmonous inflammation there is a circum- 
scribed swelling ; in erysipelas little or none. The 
pain in erysipelas is of a burning kind ; in phlegmo- 
nous of an acute throbbing nature. When erysipelas 
terminates in suppuration, the pus is not confined to 
one spot as in phlegmonous, but travels from cell to 
cell through the cellular membrane, which separates in 
sloughs resembling wetted tow. 

Q. How would you treat a wound occasioned by 
glass ? 

A. As small spicule of the glass in general remain 
in these wounds without our being able to remove 
them, it is in general most proper to apply a poultice 
as in contused wounds. 

Q. From how many causes may mortification pro- 
ceed ? 

A. From the excess or peculiarity of preceding in- 
flammation; from an interruption in the circulation of 
a part ; by pressure on its principal vessels either pre- 



>t Rt.ERY. 45 

venting the flow of blood to, or its return from it; from 
external violence; intense heat or cold, or long con- 
tinued pressure. 

Q. How are wounds penetrating the thorax to be 
treated ? 

A. Where there is merely an incision through the 
parietes of the chest, the edges of the wound are to be 
brought and retained in contact by adhesive strips, aid- 
ed by a compress, and a bandage round the thorax; 
perfect rest is to be enjoined, together with a strict an- 
tiphlogistic regimen ; occasional bleedings will be pro- 
per to prevent inflammation arising to any considerable 
extent. Should violent inflammation, nevertheless, 
come on, copious bleeding, blisters, and all the reme- 
dies proper in pleurisy, are to be immediately employed. 

Q. Previously to bringing the edges of the wound in 
contact, is it necessary to evacuate the air from the ca- 
vity of the pleura! 

A. No: Experience and actual experiment have 
proved that air admitted in the thorax is not productive 
of those injurious effects which it was once supposed 
to be. 

Q. What is the proper treatment for mortification 
arising from inflammation ? 

A. The great business of the surgeon should be 
rather to prevent the occurrence of mortification, by 
carrying the depleting remedies as far as the system of 
the patient will allow ; when, however, mortification 
has actually come on, and the patient sinks, a judicious 
cordial regimen, with tonics, will be required. The 
best local application appears to be, according to the 
experience of Dr. Physick, a blister, of sufficient size 
to extend to the sound parts in contact with that in 
which the mortification is seated; where this, how 
ever, cannot be applied, a common poultice, combined 
with powdered charcoal, or the fermenting poultice, are 
to be employed- 

(,>. What is the nature of gun-shot wounds? 

A, They partake of the nature of contused wounds; 



SURGERY. 

the parts forming the sides of the wound being in gc 
neral killed by the ball, they must be thrown off in the 
form of sloughs, before the wound can heal. These 
wounds likewise frequently contain portions of cloth- 
ing, splinters, and the ball, &c. 

Q. What is the mode in which a gun-shot wound 
should be treated ? 

A. Any extraneous substances, such as the ball, &c. 
that can be perceived, and removed with ease, should 
be extracted ; but, as these are generally in contact 
with dead matter, and will therefore be productive of 
no inconvenience, but will be removed with the sloughs, 
it is not necessary or proper to dilate the wound, or 
use much exertion in order to extract them : the com- 
mon poultice is the most proper application to the 
wound, until the sloughs separate, when the sore is to 
be treated by the adhesive strips. The separation of 
sloughs should be carefully watched, as it frequently 
happens that the coats of a large artery have been kill- 
ed by the ball ; and when the dead parts separate, pro- 
fuse haemorrhages will be liable to occur, unless atten- 
tion be paid to this circumstance. When a limb has 
been torn off by the ball, the shattered extremity should 
be immediately amputated. 

Q. If blood be effused in the chest from a wound, 
what is to be done ? 

A. The blood is to be evacuated. If the original 
wound be too small for this purpose, it is to be diiated 
with a scalpel; afterwards, the edges of the wound are 
to be placed accurately in contact, and kept so by ad- 
hesive plaster. 

Q. How is hxmorrhagy from one of the intercostal 
arteries to be commanded ? 

A. The artery is to be dissected down to,' and a liga- 
ture may now be carried round it, by means of a needle 
secured in a small curved forceps, as invented by Dr. 
Physick for staking up deep-seated vessels. 

Q. How are gun shot wounds of the thorax and lunn 
.to be treated 3 



SURGERY. 47 

A. Blood should be drawn to a considerable extent, 
and a poultice of bread and milk, secured in a fine mus- 
lin bag, is to be applied upon the orifices made by the 
ball, until the sloughs separate. 

Q. In what manner do wounds of the thorax occa- 
sion emphysema? 

A. In general, by the lung being wounded, and the 
air which escapes into the chest, being incapable, from 
the obliquity, or the small size of the exterior opening 
of the wound, to pass externally, is forced into tlte cel- 
lular membrane, which it distends, sometimes only in 
the vicinity of the wound, but at others, in its whole ex- 
tent over the body. 

Q. What is the proper treatment of emphysema ? 

A. Punctures with a lancet in the vicinity of the 
wound ; but if these do not prove effectual, a free in- 
cision must be made into the thorax, which at once 
puts a stop to the complaint. 

Q. What are the general symptoms of a fracture ? 

A. Sudden pain at the time of the accident -, defor- 
mity, or a change in the figure of the part, with an in- 
capability of performing its functions without pain to 
the patient ; crepitation, or a grating noise caused by 
rubbing together the fractured extremities of the bone; 
and, if in a limb, in general, a shortening of it, and a ca- 
pability of bending it at the place of fracture. 

Q. How would you treat a wound penetrating the 
abdomen ? 

A. After ascertaining that none of the viscera had 
been wounded, I would place the edges of the wound, 
if it be made with a sharp instrument, in contact, and 
retain them so by the interrupted suture, passing the 
needle from within outwards, and by placing the body 
in such a position as shall most effectually relax the 
abdominal muscles. Inflammation is to be prevented 
from supervening, by the usual depleting remedies, 
confining the patient at the same time, to a strict anti- 
phlogistic regimen. 

Q. What are the properties of pus > 



43 SURGERY. 

A. It is a fluid of the consistency of cream, composed 
of globules swimming in a fluid, which is coagulable by 
muriate of ammonia- It is of a light straw colour, per- 
fectly free from any acrimony, and sinks in water with- 
out mixing with it. 

Q. What do you mean by a fungous ulcer ? 

A. When the ulcer, in place of forming healthy firm 
granulations of a florid colour, and proceeding on re- 
gularly to cicatrization, throws up large flabby granu- 
lations, which rise considerably above the surrounding 
parts, and have no disposition whatever to cicatrize. 

Q. What is the treatment proper for a fungous ulcer ! 

A. We should attempt, at first, to suppress the fun- 
gus by pressure, made by a roller, or by the adhesive 
strips ; should this prove ineffectual, the different 
escharotics should be resorted to, varying them accord- 
ing to circumstances. The red precipitate, the nitrate 
of silver, burnt alum, blue vitriol, &c have all been 
found beneficial. Should one not succeed, another 
should be substituted. 

Q. How is a wound or rupture of the tendo achillis to 
be treated ? 

A. The foot is to be extended, and kept so by means 
of a splint secured on the instep by a roller ; the in- 
equalities of the leg being filled up by compresses. 
The edges of the divided tendon must be placed ac- 
curately in contact, and if a fold of the skin is found to 
insinuate itself between the divided ends, this must be 
prevented by the proper application of a portion of ad- 
hesive plaster. 

Q. What symptoms would induce you to suppose an 
artery wounded ? 

A If the vessel be of any size, there would be an 
immediate stream of blood of a bright scarlet colour, 
which is thrown out per saltum, or, as it were, by ir- 
regular jirks. 

Q. What is meant by cicatrization? 

A. It is that process by which, after any loss of sub- 
stance has been supplied by granulation, an ulcer or 



SURGERY. 49 

wound heals ; or in other words, by which the produc- 
tion of new skin over a wound or ulcer is effected. 

Q. What are the circumstances of a fracture of the 
bones of one of the extremities tliat would induce you 
to recommend immediate amputation ? 

A. The principal arteries of a limb being destroyed, 
the bone being ground, as it were, into many different 
pieces, and accompanied with a contused wound of the- 
soft parts, as in the case of a large body falling on a 
limb, or of a broad heavy wheel passing over it; the 
bones constituting a joint being crushed ; the frac- 
ture being complicated with a luxation of one of the 
larger joints, are circumstances that should induce a 
surgeon to recommend immediate amputation, provid- 
ed inflammation had not taken place. 

Q. What are the symptoms that would induce you 
to suppose a luxation of a bone had taken place ? 

A. Pain, and inability to move the member, a change 
in ihe length of the limb, and in the form of the joint. 

Q. What is meant by granulations ? 

A. They are exudations of coagulable lymph from 
the vessels of the exposed surface, which soon become 
organized, and uniting together, supply any loss of sub- 
stance produced by the ulcerative process. They are 
of a florid red colour, and contain vessels, nerves, and 
absorbents. 

Q. What is meant by a compound luxation ? 

A. A luxation complicated with an external wound of 
the soft parts, communicating with the cavity of the 
joint. 

Q. What is meant by a hernia ? 

A. The protrusion of some of the viscera of the ab- 
domen through its parietes. 

Q. What do you mean by crural hernia ? 

A. When the viscera pass out under the crural arch 
or Foupart's ligament. It is likewise sometimes called 
femoral hernia. 

Q. What is meant by hernia congenita? 

A. A hernia occurring at or soon after birth, in which 
E 



,0 SURGERY. 

the intestines pass through the opening at which the 
testicle escapes from the abdomen ; the tunica vaginalis 
testis constituting the hernial sac. 

Q. What do you understand by inguinal hernia or 
bubonocele ? 

V. When the viscera escapes from the abdomen at 
the abdominal ring. 

Q. When the intestinal sac contains only intestine, 
what is it named ? 

A. Enterocele. 

Q. What is the hernia called when the viscera pass 
through the umbilicus ? 

A. It is called exomphalos or umbilical hernia ; and 
sometimes omphalocele. 

Q When the sac contains omentum only, what is it 
called ? 

A. Epiplocele. 

Q. What do you mean by reducible hernia ? 

A. When the protruded viscera can be readily pass- 
ed back into the abdomen. 

Q. What is meant by strangulated or incarcerated 
hernia ? 

A. When the tumor cannot be reduced in conse- 
quence of the parts about the orifice at which the vis- 
cera protrude, forming a stricture round the neck of 
the sac. 

Q. What do you mean by oscheocele I 

A. When the tumor in inguinal hernia extends to the 
scrotum, it is thus denominated. 

Q. Can a hernia be irreducible without being stran- 
gulated ? 

A. Yes ; adhesions very frequently form, connecting 
the contents of the sac to each other, and also to the 
sac, and preventing their repassage into the abdomen. 

Q. When the sac contains both omentum and intes- 
tine, what is it called I 

A. Enterp-epiplocele. 

Q, What is the mode, generally speaking, in which 
dislocations are reduced? 



SURGERY. 51 

A. By extension and counter extension. 

Q. What is meant by thest- terms ? 

A. Uy extension is meant that force which is applied 
to the dislocated bone, to draw it out of its unnatural 
situation : by counter extension, the force applied to 
prevent the bone to which the luxated one is articu- 
lar u, from being moved by the extending force- 

Q. What are the principal obstacles to the reduction 
of a luxated bone ? 

A. The action of the muscles is the most consider- 
able; difficulty is also sometimes occasioned by the 
head of the bone having passed over, or hitching on 
some bony prominence in the neighbourhood of the 
joint. 

Q By what means are these obstacles to be over- 
come? 

A. The resistance of the muscles may be overcome, 
where the constitution of the patient will admit of it, 
by copious bleeding, as recommended by Dr. Physick, 
or by nauseating doses of emetics, or the tobacco clys- 
ter. The other obstacle is to be overcome by a proper 
direction of the extending force, or by lifting the head 
of the bone out of the position into which it has passed. 

Q. What are the symptoms of concussion of the 
brain ? 

A. At first, there is insensibility coldness of the ex- 
tremities, difficulty of breathing, but without any ster- 
tor, and an intermittent pulse. The pupil of the eye 
is either dilated or contracted. In general, the respira- 
tion and pulse, after a time, gradually become more 
natural, and the extremities regain their warmth; the 
patient, though still stupid, is sensible, if his skin be 
pinched, and becomes able to answer questions put to 
him in a loud tone of voice ; and a vomiting frequently 
occurs. 

Q. What is the great danger to be apprehended from 
a concussion of the brain ? 

A. The occurrence of an inflammation of that organ, 
when a reaction of the vessels takes place. 



52 SURGERY. 

Q. What is the treatment for a concussion of the 
brain ? 

A. When called in, soon after the occurrence of the 
accident, all ligatures should be removed from about 
the patient's neck ; his head is to be shaved, and cloths 
wrung out of cold water applied to it, and renewed as 
they become warm ; as soon as the patient is capable 
of swallowing, a mercurial cathartic should be admi- 
nistered, and if tardy in its operation, this should be ac- 
celerated by a dose of the infusion of senna. As soon 
as the pulse and system of the patient rises, bleeding 
is to be resorted to, and repeated as often as the pulse 
shews any tendency to rise. Blisters are at the same 
time to be applied to the head and back of the neck ; 
and the patient is to be confined to a strict antiphlogis- 
tic regimen. 

Q. How should a wound of the stomach be treated < 

A. After removing any extraneous matter which can 
be discovered in the vicinity of the wound, without 
much disturbing the parts, the wound in the stomach is 
to be secured by a sufficient number of stitches, and 
the stomach returned into the abdomen, the ligatures 
being cut off close to the kno»\ Afterwards the exter- 
nal wound is to be closed by the interrupted suture. 
The occurrence of any undue degree of inflammation 
and fever, is to be guarded against by bleeding, &c. 
and the antiphlogistic regimen. 

Q. What becomes of the portions of thread left in the 
wound of the stomach ? 

A. A layer of coagulable lymph is thrown over them, 
externally, which prevents them from escaping into the 
cavity of the ibdomen, when separated by ulceration ; 
they pass, therefore, into the cana! of the intestines, and 
are evacuated with the feces. 

Q. What ar~ >!>< symptoms of an indolent ulcer? 

A. A high, indurated, smooth, and rounded edge; 
• imperfectly formed pus; smooth glossy granulations. 
1'hc bottom of the ulcer is level, and here and there is 



SUKGERV. jj 

of a white colour, from the adhesion of portions of co- 
agulable lymph. 

Q, Wliat is the treatment proper for an indolent 
ulce, ? 

A Almost all the escharotfc and stimulating articles 
of the materia medica have been recommended in the 
treatment of this ulcer ; most of them, in different 
cases, have been found beneficial, and they may be em- 
ployed according to circumstances. When one is found 
ineffectual, or to aggravate the ulcer, it should be 
changed for another. Dr. Physick has very successful- 
ly treated this species of ulcer, by completely destroy- 
ing the edges and surface of the sore with the knife or 
caustic. He in general prefers the latter. Dr Baynton 
lias introduced a mode of treating indolent ulcers, which 
is very generally adopted in conjunction with the em- 
ployment of the remedies already mentioned. This 
practice is to apply adhesive strips over the ulcer, so as 
to draw its edges somewhat together, and afterwards, 
to envelope the extremity in a cotton roller. 

Q. ltecite some of the applications most generally 
employed in the treatment of indolent ulcers. 

A. The red precipitate and corrosive sublimate of 
mercury; blue and while vitriol; caustic potash; the 
carbonates of soda and of potash ; sulphuric, nitric, 
and muriatic acids; gastric juice; alcohol; rhubarb, 
&c. &c 

Q. What are the symptoms of aneurism 1 

A. It commences with a throbbing and a tumor, 
which is entirely free from any inflammatory symptoms, 
at the seat of the disease. The tumor gradually aug- 
ments in bulk, until it sometimes acquires a very con- 
siderable size. It may, at first, be made to disappear 
by pressure, but returns immediately upon the removal 
of the pressure. The subsidence of the tumor may 
also be produced by pressure upon the artery between 
it and the heart. The tumor augmenting in bulk, the 
pulsation becomes less, and sorm times is even entirely 
suspended. If the aneurism be seated in a limb, and is 
e 2 



54 SURGERY. 

of some size, a numbness and oedema of the parts below 
the tumor, are very frequently occasioned by its pres- 
sure upon tbe nerves and vessels. 

Q.. How do aneurisms terminate when left to them- 
selves 1 

A. By the pressure of the tumor, an absorption of the 
surrounding parts takes place, and the aneurism is al- 
lowed room to enlarge itself; at length, however, the 
coats of the sac are thinned by the absorbents, and a 
slough forms, or they give way from some extraordi- 
nary exertion, and an immense gush of blood following, 
puts an end at once to the life and sufferings of the pa- 
tient. 

Q. What is the general treatment of a fractured ex- 
tremity f 

A. The limb is to be placed in such a situation as 
most effectually to relax its muscles; extension and 
counter-extension is now to be made, and the ends of 
the bone being placed in contact, are to be retained so 
by the application of splints and bandages. If inflam- 
mation has occurred to any extent previously to the ar- 
rival of the surgeon, it is better, before attempting to 
set the fracture, to wait until it subsides, employing, in 
the mean time, the proper remedies to combat it. Too 
great a degree of inflammation arising during the heal- 
ing of the fracture, is to be treated by bleeding; and 
if in an upper extremity, by purging. When there ex- 
ists extensive ecchytnosis, copious depletion and cold 
applications will prevent the occurrence of an abscess. 

Q. In cases of fractures occurring in intemperate 
habits, is there any modification of treatment necessarj ' 

A. Yes : Any considerable accident occurring in such 
habits, is apt to induce spasm, or even delirium and 
death. To guard against these consequences, the pa- 
tient must be allowed, regularly, a proper quantity of 
'.pirituous liquors, graduated according to his former 
habks, and he is to be kept on rather a nourishing diet. 
It should also be recollected, that these patients will 
not bear any degree of depletion 



SURGERY. Sj 

Q. Supposing the fractured bone will not take on 
bony union, as is sometimes the case, but still continues 
to bend at the place of the accident, what can be done 

A. If, after nine or ten weeks, it is found that no 
union has taken place, the surgeon should endeavour 
to excite a proper degree of inflammation in the part, 
by forcibly rubbing the fractured extremities together, 
and afterwards replacing the dressings as at first. This 
will sometimes succeed, but if it should not, the opera- 
tion introduced by Dr. Physick, of passing a seton be 
tween the fractured ends, extension and counter-ex ten 
sion being made at the time, is to be performed. The 
seton is to be kept in until bony union commences. 

Q. How are wounds of the joints to be treated ? 

A. The limb must be placed, and if possible, by pro- 
per splints and bandages, retained in such a position as 
shall Favour the approximation of the edges of the 
wound. Adhesive strips are to be applied, but no su- 
ture should be employed. Absolute rest, and a strict 
adherence to an antiphlogistic regimen, arc to be en- 
joined. As the most distressing consequences are to 
be apprehended from inflammation occurring in a joint, 
every exertion should be made to prevent it. If any 
symptoms of it occur, bleeding is immediately to be re- 
sorted to, and carried as fur as the patient's constitution 
will permit. Topical bleeding by leeches, or cupping, 
is next to be employed, and followed by the early ap- 
plication of a large blister to the joint; and the patter- 
must be confined to a low diet. 

Q. When inflammation has occurred in a joint, and 
notwithstanding our remedies, from its violence and 
long continuance, an anchylosis is apprehended, what 
is to be attended to ? 

A. To place the limb in such a position as shall be 
most convenient to the patient, when anchylosis has ac 
tually taken place. Thus, when tlie part affected is 
the elbow, the arm is to be kept flexed; when the hip 
or knee, the limb must be preserved in a state o 
tension. 



SURGERY. 

Q. What are the symptoms of a compression of the 
brain ? 

A. In general there is a complete loss of sense, 
speech, arid voluntary motion, will) stertorous breath- 
ing, and :• dilatation of the pupils, winch cannot be 
altered by the strongest light; the pulse is slow and 
irregular, and the limbs are in a state of relaxation. 

Q From how many causes may compression of the 
brain arise ? 

A. Either from an effusion of blood within the cra- 
nium, or from the depression of a portion of the scull. 

Q. How may compression from effused blood be dis- 
tinguished from concussion ? 

A. The discrimination is sometimes very difficult. 
In forming a judgment, it is to be recollected that the 
symptoms of concussion always follow immediately on 
the receipt of the injury, and the patient gradually re- 
covers from the state of insensibility in which he at 
first was ; when, therefore, any time lias elapsed be- 
tween the accident and the occurrence of the symp- 
toms of compression, or if, after recovering from the 
'.fleets of the concussion, symptoms of compression 
come on, we may conclude, with some degree of cer- 
lainty, that the symptoms are caused by effused blond 
within the cranium, and we should proceed accord- 
ingly. 

Q What is proper to be done in such a case ? 

A To remove a portion of the scull with the tre- 
phine, in order to permit the evacuation of the blood. 

Q. At what part of the scull are we to perform this 
opei ation ! 

A. If the spot, at which the injury that induced the 
extravasation was inflicted, can be ascertained, this 
will be the proper place for trie perforation. If this 
cannot, however, be done, the perforation should be 
made over the course of the middle artery of the dura 
mater, at the anterior inferior angle of the parietal 
bone. If after perforating one side of the head, no col- 



svRUKttY. :;r 

lection of Wood is discovered, the operation is to be re- 
peated on the opposite side. 

Q. How may femoral be distinguished from inguinal 
hernia ? 

A. In the former, the whole extent of the angle of 
the pubis and the whole length of the crural arch can 
be felt, which is not the case in the latter. The neck 
of the hernial sac in the latter, also, may be traced to 
the abdominal ring. 

Q. What are the symptoms that indicate the exist- 
ence of strangulation in hernia ? 

A. There is an insuperable costiveness, acute pain in 
the tumor, particularly at the place of stricture, and 
extending from thence over the abdomen, which soon 
swells and becomes tense. The pain, which was not at 
first constant, becomes fixed, and is augmented by 
pressure and by coughing, sneezing, &c. ; nausea and 
vomiting come on. The matter thrown up is at first 
the contents of the stomach, but afterwards becomes 
foccal ; the pulse is quick and hard, and the extremities 
are cold ; the patient becomes affected with hiccups, 
and his pulse is now scarcely perceptible ; his respira- 
tion is weak, and his whole body is covered with a cold 
clammy sweat. Mortification now takes place in the 
contents of the tumor, which extending, puts a period 
to the life of the patient. 

Q. How would you distinguish inguinal hernia from 
hydrocele ? 

A. In the latter, the swelling commences at the bot- 
tom of the scrotum and extends upwards, in place of 
commencing at the ring, as in inguinal hernia, and pro- 
ceeding downwards. Hydrocele is not dilated, as is 
hernia, by coughing, and appears transparent, when 
examined opposite a candle ; the spermatic chord, 
which, in inguinal hernia, is easily distinguished behind 
the tumor, cannot at all be felt in hydrocele. 

Q What are the symptoms of reducible hernia I 

A The swelling is sod, free from pain, and of the 
latural colour ot the skin ; the parts are readily re- 



58 SURGERY 

turned into the abdomen ; the tumor is larger ii 
erect than in :i ueumbent posture, and is inlaiged by 
coughing, sneezing, vomiting, straining at stool, &c. 

Q: How may femoral hernia be distinguished from 
lumbar abscess, when the latter appears in the groin ? 

A. ft' the patient belaid upon his back, and pressure 
be made with one hand upon the tumor, and the other 
upon the abdomen, if it be an abscess a fluctuation will 
he felt, which cannot be produced in a hernial tumor. 
The history of 'he case likewise wiil assist us in deter- 
mining the nature of the swelling. 

Q. How is strangulated hernia to be treated ? 

A. We should endeavour to return the parts as 
speedily as possible into the abdomen, provided they 
are free from gangrene. This is to be attempted by 
placing the patient on his back, with his hips and shoul- 
ders raised; and the thighs, if it be an inguinal or femo- 
ral hernia, are to be bent on the pelvis, and at the 
knees, and also rolled inwards.. The surgeon should 
now attempt, by gentle and judiciously directed pres- 
sure, with the hand, to reduce the tumor ; if this be 
unsuccessful, blood is to be drawn from the arm until 
symptoms of fainting ensue, and the efforts to reduce 
the tumor should be now repeated. The parts still 
refusing to pass into the abdomen, the warm bath, if at 
hand, should be resorted to, and the taxis again repeat- 
ed ; this proving unsuccessful, cold may be applied to 
the tumor, and incase of its failure, recourse should be 
immediately had to the tobacco injections. If all these 
means fail, the surgeon must lose no time, hut imme- 
diately operate. 

Q. In what direction should the taxis be made in our 
attempts to reduce femoral hernia ? 

A. At first directly downwards, as though we were 
pressing i he tumor into the thigh, and when its sur- 
face is reduced to a level with the crural arch, we are 
then to press it upwards towards the abdomen. 

Q. Why should the taxis be applied thus ? 
\ This will be very evident, when it is recollected 



SURGERY. 

-that the direction of the contents of the hernia, 'in escap- 
ing from the abdomen, is at first downwards, until they 
protrude Irom under the crural arch, when they pass di- 
rectly forwards. If, therefore, we were at first, in place 
of pressing the tumor, as it were, against the thigh, to 
push it towards the abdomen, it would, in place of pass- 
ing into that cavity, turn up over the edge of the arch, 
and no degree of force applied in that direction could 
possibly reduce the hernia. 

Q. In what direction are we to apply our force in the 
reduction of inguinal hernia by the taxis ! 

A. Ohliquel> upwards and inwards, in the direction 
of the abdominal canal. 

Q. How would you treat a dislocation of the inferior 

j# w • 

A. The patient being seated on a low stool, his head 
is to be supported by an assistant behind. The sur- 
geon wrapping around his thumbs the ends of a towel, 
places them as far back as possible upon the molar 
teeth, and while he forcibly depresses these, with his 
fingers plated beneath the chin, he elevates the fore 
part of the jaw ; as soon as he finds the jaw to move, 
he pushes it a little backwards, and at the same time 
slips his fingers between the teeth and cheeks, lest they 
be bitten by the jaw, which, at the moment of its re- 
duction, closes with considerable force. The jaw is to 
be retained in its position by a bandage passed over the 
head and under the chin, and the patient is to be nou- 
rished for some time on spoon victuals. 

Q. How is a compression of the brain, from a frac- 
tured cranium, to be treated ? 

A. By removing, with the trephine, the depressed 
portion of bone, and guarding against inflammation by 
proper depletion. 

Q. What are the principal cautions necessary in per- 
forming the operation of trephining ? 

A. 1st, in making the incision through the scalp, to 
guard against plunging the knife, through the fracture, 
into the brain ; 2d, always to apply the centre pin of 



, g SURGERY. 

the trephine upon a firm portion of the cranium ; 3d, 
to recollect to retract the centre pin, after a sufficient 
groove has been formed for the crown of the instru- 
ment ; 4th, frequently to ascertain, with a tooth-pick, 
the depth to which the saw has penetrated, being care- 
ful that it has not arrived in any portion of the groove 
at the dura mater ; 5th, when the trephine has reached 
the tabula vitrea, rather to break out the piece of bone 
by the elevator, than to cut completely through with 
the saw. 

Q. Does every case of fractured cranium require the 
application of the trephine ? 

A. The trephine is to be employed in no case of 
fractured cranium, excepting in those accompanied with 
symptoms of compressed brain. 

Q. How would you treat a fractured rib ? 

A. By applyinga broad bandage around the thorax, 
as tightly as the patient can bear, in order to prevent 
the action of the ribs in respiration displacing the frac- 
tured edges. Undue inflammation is to be counter- 
acted by the usual depleting remedies ; if the patient 
be troubled with a cough, he must make use of some 
demulcent mixture. 

Q. What is the treatment proper in a case of oph- 
thalmia? 

A. Bleeding, general and topical, and purging with 
the saline cathartics, carried to such an extent as the 
violence of the symptoms shall demand. After bleed- 
ing, a blister is to be applied to the temples, or behind 
the ears; the antimonial powder will also be proper. 
The patient must be confined to a dark room, and kept 
on a strictly antiphlogistic regimen. In the first stage, 
simple cold water, or milk and water, may be applied 
to the eye by means of cloths wet with them, and fre- 
quently renewed ; at a latter stage, these should be 
changed for a collyrium composed of a proper propor- 
tion of sugar of lead and white vitriol dissolved in wa- 
ter. If the inflammation continue in spite of our reme- 



SURGERY. 61. 

dies, a salivation should be induced by the active use 
of mercury both externally and internally. 

Q. What do you mean by a cataract ? 

A. An opacity of the crystalline lens, or of its cap- 
sule, or of both. 

Q. What do you understand by a hare lip ? 

A. A congenital deformity, consisting in a fissure of 
the upper lip, varying in its extent. 

Q. How is it to be treated ? 

A. A portion of the edges of the fissure, of the form 
of the letter V inverted, is to be removed by means of 
sharp scissors. The edges are now to be placed in 
contact, and two silver pins passed through both sides 
of the wound, entering and bringing them out about 
half an inch from it. A waxed ligature is next to be 
twisted round each pin in the form of the figure 8, in 
such a manner as to retain the edges in contact. 

Q. What is meant by a polypus? 

A. It is a fleshy tumor, originating from the inner 
parts of the different cavities, varying in its size and 
nature. 

Q. What symptoms result from wounds of the abdo- 
minal viscera ? 

A. Profuse haemorrhages, the escape of the contents 
of the different viscera, a small, feeble, and contracted 
pulse, pallid countenance, coldness of the extremities, 
great prostration of strength, hiccough, vomiting, ten- 
sion of the abdomen, and spasm. 

Q. When, after the operation of trephining, the dura 
mater is protruded through the opening by blood ef- 
fused between it and the pia mater, what is to be 
done? 

A. If the tumor is considerable, and we are assured, 
from the circumstances, that it contains fluid blood, a 
small puncture may be made through the membrane 
with a sharp lancet to let it out ; but, from the danger 
resulting from wounds of the dura mater, we should, 
except under the above circumstances, trust to the re- 
moval of the effused fluid by the absorbents, at ths 
F 



62 SURGERY. 

same time bleeding and purging the patient actively, 
confining him to a very abstemious regimen, and en- 
joining perfect rest. 

Q. What is meant by a hydrocele I 

A. The term is generally made use of to signify 
a morbid collection of water in the tunica vaginalis 
testis. 

Q. What are the appearances of a hydrocele ? 

A. It is a pyriform, somewhat tense and elastic tu- 
mor, in which a fluctuation can in general be felt. It 
is somewhat transparent when held before the light; 
the skin retaining its natural colour. 

Q. How may it be distinguished from an anasarcous 
swelling of the scrotum ? 

A. The latter is generally a symptom of universal 
dropsy. The tumor, in place of being tense, is doughy 
to the feel, and any impression made in it remains for 
some time ; the swelling is not confined to the scrotum, 
as in hydrocele, but extends also to the penis- In hy- 
drocele, the testicle can be felt at the inferior posterior 
part of the tumor, but in anasarca of the scrotum, they 
are imbedded in the centre of the swelling, and cannot 
be distinguished. 

Q. How is hydrocele to be treated I 

A. To relieve the inconveniency arising from the bulk 
and weight of the tumor, the water may be drawn off, 
through a puncture, with a common lancet ; this, how- 
ever, is only palliative, and the water again speedily 
collects. To effect a radical cure, after drawing off 
the water by a trocar and canula, wine diluted with wa- 
ter must be injected through the canula into the cavity 
of the tunica vaginalis, so as to distend it, and retained 
there until pain is experienced in the back and loins, 
when it is to be permitted to run off. Should too great 
a degree of inflammation arise, bleeding, &.c. is to be re- 
sorted to. 

Q. What are the cautions requisite in performing 
this operation ? 

A. 1st, to ascertain the exact situation of the testicle. 



SURGERY. 63 

m order to avoid piercing it with the trocar ; and 2d, 
by pincing a fold of the skm, surrounding the opening 
made in the scrotum, between the finger and the guard 
of the canula, to prevent the canula from slipping out 
of the cavity of the tunica vaginalis testis ; otherwise, 
the cellular membrane of the scrotum may be injected 
with the wine, and mortification ensue. Previous to 
determining on the operation, we should also be cer- 
tain that the testicle is free from disease. 

Q. How does the injection of the tunica vaginalis 
testis effect a radical cure of hydrocele ? 

A. By exciting inflammation throughout the cavity, 
which causes an adhesion of its sides to take place. 

Q. What are the symptoms of an inflammation of a 
vein consequent to venesection ? 

A. There is at the orifice, made by the lancet, a hard 
painful tumor, from which an erysipelatous redness ex- 
tends to some distance around. Flexion and extension 
of the arm are productive of much pain to the patient. 

Q. What is the cause of this affection ? 

A. In general inattention on the part of the surgeon, 
in not closing the orifice made in the vein by the lancet, 
so that it shall unite by the first intention. 

Q. How is the disease to be treated? 

A. On its first appearance, Dr. Physick recommends 
the application of a blister, large enough to cover all 
the inflamed parlr,. A portion of adhesive plaster is to 
be put on the orifice in the vein, previously to the ap- 
plication of the blister If, however, the inflammation 
is considerable, and fever arises, bleeding, purging, and 
the antiphlogistic regimen must be had l'ecourse to; 
at the same time keeping the arm at rest by means of 
a splint. Dr. Hunter advises compresses to be applied 
so as to induce an adhesion of the sides of the vein at the 
inflamed part, or if suppuration has commenced, above 
the suppurating part. 

Q. How is a fracture of the neck or head of the hu- 
merus to be distinguished from a dislocation of that 
bone into the axila ' 



SURGER\. 

V In both there is a depression at the upper and 
i'oiv part of the arm. In the dislocation, this depression 
is immediately beneath the acromion scapula:, and the 
shoulder is flattened; but in the fracture it is lower 
down, and the shoulder retains its rotundity. In the 
dislocation, the round head of the bone can be distiii- 
gu ; shed high up in the axila; in the fracture, in 
place of it, we feel the rough edge of the fractured 
bone, and by moving the arm crepitus may be induced. 

Q. What is meant by a hematocele ? 

A. A swelling of the scrotum, occasioned by blood, 
effused either in the cellular membrane, or in the cavi- 
ty of the tunica vaginalis. 

Q. How is scrotal hernia distinguished from hema- 
tocele ? 

A. By the firmness of the tumor in the latter case, 
its being accompanied with a dark redness of the skin, 
its not being dilated upon coughing, and by there be- 
ing no swelling in the course of the spermatic chord. 

Q. How is hematocele to be treated ? 

A. We should endeavour to induce an absorption of 
effused blood by cold applications ; the affusion of cold 
water upon the swelling ; by a due degree of pressure 
by a proper bandage, and by the occasional administra- 
tion of purgatives. 

Q. How is a fractured clavicle to be managed ? 

A. In order to reduce the fracture, and preserve the 
fragments in such a position as they shall unite without 
deformity, it is necessary the shoulder be kept for- 
wards, upwards, and backwards; to effect this, the pa- 
tient is to be placed on a seat without a back, and his 
arm, on the affected side, being raised by an assistant, 
and held at a right angle with the body, a pad, made in 
the form of a wedge, about three inches thick at its 
base, is to be placed in the axila, with the thickest end 
uppermost, and secured there by a roller passed round 
the thorax. The fore arm being half bent, the surgeon 
is now to take hold of the elbow, and press the arm 
close down over the pad, at the same time pushing the 



SURGERY. bj 

humerus upwards, and its upper extremity a little 
backwards. The arm is to be secured in its present si- 
tuation by a bandage passed round it and the thorax, to 
extend from the shoulder to the elbow, and the shoul- 
der is to be kept, elevated by a bandage which com- 
mences at the sound axila, is to be passed over the 
breast, across the injured shoulder, along the posterior 
part of the arm, and around under the elbow ; from 
hence it is again to be carried obliquely across the 
breast to the sound arm pit, then across the back over 
the injured shoulder, and in front of the arm to the el- 
bow, thence it is to be passed across the back to the 
spot from which it originally started, and to commence 
its course anew. The dressings are to be frequently 
examined, and renewed when they become loose. 

Q Why is the humerus more frequently dislocated 
than any other bone? 

A. From the very superficial cavity into which the 
head of the bone is articulated, from the laxity of the 
ligaments of the joint, and from the great extent of its 
motions, exposing it to frequent accidents. 

Q. What are the symptoms of the formation of a 
cataract ? 

A. The disease is in general very slow in its ap- 
proach. The first symptom is an appearance, to the 
patient, of small motes or films floating before the eye; 
at this period the eye does not present to the sight any 
alteration in its appearance. The disease advancing, 
all objects appear to the patient to be obscured by an 
apparent mist, and his vision gradually becomes more 
and more impaired, until he is at length unable to dis- 
cern the objects around him, although he may be able 
to distinguish the situation of a strong light, or of the 
windows in a room. A turbid whiteness is at first per- 
ceived in the lens, which increases until a perfect opa- 
city takes place. 

Q. What is the proper treatment in the incipient stage 
of cataract ? 

A. We should endeavour to prevent the further pro- 
f 2 



jo SURGERY. 

gressofthe disease, by resorting to the usual depleting 
remedies, bleeding, purging, blisters, mercury, setons, 
and issues, together with a low diet ; and the depletion 
should be carried to such an extent as the patient's 
costitution will allow- 

Q. What are the symptoms in cataract that would 
induce us to prognosticate a favourable result from an 
operation ? 

A. When it occurs in a person of a sound constitu- 
tion ; is unconnected with any other disease of the eye, 
and has not originated from an external violence ; when 
the pupil freely contracts on exposure to light, and 
when it is not more dilated than it would naturally be 
in a similar degree of light ; when the patient is free 
from pains in his head, eyes, or eyebrows; and when he 
still retains the power of discriminating vivid colours, 
and the outlines of such bodies as are presented to 
him. 

Q. What is meant by a ranula ? 

A. A tumor, situated under the tongue, consisting of 
a sac containing a thick glairy fluid, and sometimes a 
calculus concretion. 

Q. How is it to be treated ? 

A. The best mode is, in general, to pass, by means 
of a curved needle, a seton through the tumor, where 
it is to be left until inflammation and suppuration ot the 
cavity take place. 

Q. How would you remove a portion of the tongue ! 

A. By passing a double ligature, by means of a nee- 
die, through the tongue, beyond the part to be remov- 
ed ; one of the ligatures is now to be tied on each side, 
and the included portion being deprived of its circula- 
tion, will in a short time drop ofl". 

Q. How should hernia humeralis be treated ? 

A. The patient should be confined to a horizontal 
position, and his testicles should be supported by a 
proper bandage ; leeches are to be applied to the part, 
and if the symptoms are violent, bleeding from the ge- 
neral system should be resorted to, and repeated ao 



SORGERY. 67 

cording to circumstances. Saline purgatives are to be 
administered, and cold applications applied to the tu- 
mor. If A hardness remain after the inflammation has 
subsided, frictions with mercurial ointment will be 
proper. In cases of" hernia humeralis, the repeated in- 
troduction of the bougie has been found beneficial. 

Q. What is the appearance of the sac in inguinal 
hernia upon dissection ? 

A. After cutting through the skin and cellular mem- 
brane of the scrotum, a fascia, which is a production 
of the tendon of the external oblique muscle, presr.nts 
itself, varying in thickness, according to the extent and 
continuance of the hernia; beneath this fascia, is the 
cremaster muscle, thicker and more extend d than na- 
tural, forming another covering to the sac ; after cutting 
through this, we come to the proper hernial sac, which 
is an elongation of the peritonaeum, but rather thicker 
than natural. 

Q On opening a hernial sac, what would induce you 
to conclude the intestine mortified ? 

A. If it appear of a dark purple or leaden colour, 
and the blood, on being pressed out of the pari, by 'he 
finger, does not return, we may conclude it to be mor- 
tified. 

Q. Where is the humerus most frequently fractured? 

A. Near its middle. 

Q. When, in consequence of a wound in the cheek, 
the parotid duct is opened, what takes place ? 

A. If great care be not taken to close the external 
orifice of the wound, a fistulous opening is formed, 
throng!) which the saliva, in place of passing into the 
mouth flows out over the cheek. 

Q How is salivary fistula to be treated ? 

A We at first enlarge the natural orifice of the duct, 
by passing into it a silver probe, and after withdrawing 
the probe, introduce a small tube, which is also to pass 
into the orifice of the duct through winch the saliva is 
discharged ; the external edges of the wound being 
made raw, are now to be brought together in order 



68 SURGERS. 

that tliey may unite In some cases, in place ol 
above treatment it is necessary to form a new canal for 
the saliva to puss through into the mouth, by passing a 
needle obliquely from the bottom of the fistula into the 
mouth, and allowing a seton to remain in the orifice 
thus made, until its sides become callous. 

Q. What is meant by e.ircocele. ? 

A. It is a varicose distention of the spermatic veins 
in the scrotum. 

Q. How may circocelc be distinguished from scrotal 
hernia ? 

A. The patient being laid upon his back, the blood 
is to be pressed out of the enlarged veins, after which 
the finger is to be placed firmly upon the abdominal 
ring, and the patient desired to rise. If it be a hernia, 
the tumor will not return until the pressure is rem r 
but if a circocele, the swelling will in a short time be- 
come greater than before, in consequence of the pas- 
sage of the blood through the veins being interrupted. 

Q. How many kinds of stricture are liable to take 
place in the urethra ? 

A. Two ; a spasmodic and a permanent ; they may 
both be combined; a permanent stricture take 
spasm. 

Q. How are strictures of the urethra to be treated ? 

A. Either by dilating them with a bougie, or destroy- 
ing them with caustic. v 

Q. How is the application of caustic to be made to 
strictures in the urethra ? 

A. By securing on the end of a bougie a portion of 
lunar caustic; a common bougie is first to be introduced, 
in order to ascertain the. exact depth at which the stric- 
ture is situated ; and this is to be marked on the aimed 
bougie, which, after being oiled, is to be passed into 
the urethra down to the mark, and retained in contact 
with the stricture for a minute or so. The application 
of the caustic may be repeated in the course of twenty- 
four hours. 



SURGEUV. 69 

Q. From how many situations may the bladder be 
punctured ? 

A. From above the nubes, from the perinseum, or in 
males and the unimpregnated female, through the 
rectum. 

Q. When is tapping of the bladder necessary ? 
A. Whenever the urine cannot be evacuated by any- 
other means. 

CJ. What arteries are most subject to aneurism ? 
A. The aorta at its curve, and the popliteal. 
Q. What is the nature of a varicose aneurism ? 
A. A puncture being made through the coats of a 
vein, and into an adjoining artery, and the communica- 
tion thus made between the vein and the artery not be- 
ing closed, "blood from the latter is thrown into the vein, 
which dilates, forming a considerable tumor, which is 
the varicose aneurism. It has a pulsating jarring mo- 
tion ; and a hissing noise may be heard in it, occasion- 
ed by the arterial blood passing through the orifice into 
the sac. 

Q. What is the danger to be apprehended in cases 
of fractures of the humerus in the vicinity of its con- 
dyles ! 

A. The occurrence of a deformity at the elbow joint, 
consisting in the angle at the bend of the elbow being 
projected upwards, in place of sloping downwards, as 
it naturally does. 

Q. What is the proper management of the fracture, 
in order to prevent this deformity ? 

A. Dr. Physick directs the fracture to be reduced, 
and a roller to be applied from the wrist to the shoul- 
der ; two angular splints are then to be applied, so as 
to keep the fore arm Hexed at a right angle with the 
arm, and long enough to extend to the ends of the 
fingers. These are to be secured on by bringing down 
the roller over them. At the end of a week the splints 
arc to be taken off', and the arm gently flexed and ex- 
- ended several times, in order to prevent any stiffness, 
dressings are then to be reapplied as before. At 



TO SURG EH \. 

the end of twenty days, the rectangular splints are to 
be laid aside, and splints forming an obtuse angle are 
to be substituted, and kept on until the fracture has 
united. 

Q; How is a dislocation of the humerus downwards 
in the axila to be treated ? 

A. Thesu'geon, if called soon after the occurrence 
of the accident, is to make counter extension with one 
hand, against the acromion scapula:, and with the other, 
grasping the arm near the elbow, he is to make exten- 
sion. If this should not succeed, or some time has 
elapsed since the dislocation took place, the force is to 
be augmented, by making several assistants p 
against the acromion process, and the same number 
ex'end the arm. If the force that can be applied in this 
way be insufficient, a strong band, lined with buck- 
skin, may be passed over the acromion, and confined in 
its situation, by passing a piece of muslin over it on 
each side of the arm, the ends of these being held by 
an assistant; this band for counter extension may be 
fastened to a staple in the wall, or held by a number of 
assistants; a towel is now to be fastened above the 
elbotv, by several turns of a roller ; to this towel, bands 
may be attached, to be taken hold of by assistants, for 
the purpose of making extension, or it may be attached 
to pullies. These means should be aided by copious 
blood-letting, whenever the case will admit of it. 

Q. Describe the operation for the extraction of a ca- 
taract. 

A. The patient is to be placed on a scat, so situated, 
that the light shall strike the eye to he operated on, 
obliquely - The sound eye is to be covered with a com- 
press, and the patient's head is to be supported by an 
assistant, placed behind him, who is also, with that 
hand which is at liberty, to keep elevated the upper 
eye lid, by pressing it in folds against the edge of the 
orbit. The surgeon being sealed before the patient, so 
that his mouth shall be on a level with the patient's eye, 
is to draw down with one hand the under eye-lid, and 



SURGERY. 71 

taking the cataract knife in the other, is to rest his 
ringers on the patient's temple, and when the eye is 
steady, he is to push the knife into the cornea, about 
half a line distant from its connection with the sclero- 
tica, and so high up, as that the incision, when com- 
pleted, shall be sufficiently large for the escape of the 
opaque lens ; the knife is to be carried on, with a steady- 
hand, until it passes out on the side of the cornea op- 
posite to that On which it entered, and the same dis- 
tance from the sclerotica. The knife being pushed on, 
completes the incision. As soon as the knife has pass- 
ed through both sides of the cornea, the eye must be 
permitted to close. In about a minute, the eye-lids are 
to be separated, and a needle of a proper construction, 
attached to a handle, introduced through the wound! 
in the cornea, into the pupil, and by it the anterior part 
of the capsule of the lens is to be freely lacerated. A 
gentle degree of pressure being now made on the eye, 
the opaque lens will escape through the incision. On 
the eye being examined, if any opaque portions of mat- 
ter remain behind, they are to be removed by the cur- 
rette. If the capsule be found opaque, this is to be re- 
moved by a forceps. The patient, after the operation, 
is to be confined on his back for nine or ten days, in a 
dark chamber. The eye is to be covered with a com- 
press; and for fear of accidents, the patient's hands are 
to be secured down to his side. Inflammation occur- 
ring to any extent, will demand the usual depleting; 
remedies. 

C-i. What is very frequently the consequence of a 
bone being denuded to some extent of its periosteum I 

A. An exfoliation. 

Q. What do you mean by an exfoliation ? 

A. The separating, by the absorbents, of a dead por- 
tion of bone from the living, in the form of scales ox 
leaves- 

il How may this be prevented > 

A. In general, by immediately replacing the lace- 



72 SURGER\ . 

rated integuments, if they remain attached at any pajrt, 
and retaining them in their situation by a soft compress. 

Q. What' are the symptoms of a suppression of 
urine ? 

A. A great desire, with an inability, to void the 
urine j pain in the region of the bladder, which latter 
gradually swelling may be felt forming a tumor above 
the pubes; at length, the abdomen becomes tense and 
painful; difficulty of breathing-; hiccough, and cold 
sweats come on ; and the bladder, unless evacuated, in- 
flames, and finally mortifies. 

Q. What are the causes 01 a suppression of urine ? 

A. Strictures in the urethra; stone in the bladder; 
hxmorrhoidal tumors; inflammatory and other swell- 
ings in the vicinity of the urethra ; spasms of the neck 
of the bladder, or of the urethra ; an enlargement of the 
prostate gland j inflammation and thickening of the 
neck of the bladder, &c. 

Q. How would you treat a suppression of urine? 

A. If it arises from a stone in the bladder falling on 
the orifice of the urethra, a change of posture in the pa- 
tient will effect its removal ; or if from a stone impacted 
in the urethra, this may be removed by a probe bent 
at the eyed end in the form of a hook ; or, if this does 
not succeed, by cutting it out. If, however, the cause 
cannot be thus easily removed, 1 would bleed from the 
arm, administer a cathartic, place the patient in a warm 
bath, and administer a large dose of opium, by the 
mouth, or an anodyne injection. 

Q. Provided the suppression did not yield to this 
treatment, what would you do ? 

A. I would endeavour to introduce the catheter. 

Q What is meant by a lumbar abscess ? 

A. Ii is a collection of pus, commencing in the loose 
cellular membrane surrounding the psox muscles, and 
posterior to the peritonaeum. 

Q Where does lumbar abscess in general point ? 

A. It, in general, travels down behind the peritonae- 
um, until it arrives beneath Povpart's ligament, or at the 



SURGERY. To 

upper and fore part of the thigh, where it forms a tu- 
mor, varying in size, in different cases. It sometimes 
points, however, in the middle of the thigh, or in the 
vicinity of the anus. 

Q. What are the symptoms which generally precede 
the formation of this abscess ? 

A. There is a sense of weakness, with a dull pain in 
the loins; the thigh on the affected side becomes weak ; 
the patient finds standing and walking difficult, and he 
bends the body forwards so as to relax the muscles. 

Q. What is meant by a paronychia, or whitlow ? 

A. It is an inflammatory affection, seated at the end 
of the finger near the nail, attended with excessive 
pain, and terminating generally in suppuration. 

Q. How many kinds or varieties of paronychia are 
there ? 

A. Four: the first is seated beneath the cuticle; the 
second beneath the true skin in the cellular membrane ; 
the third in the theca of the tendons ; and the fourth on 
the periosteum. 

Q. What are the principal circumstances calling for 
an amputation of a limb ? 

A. Extensive compound fractures, attended with 
severe injury of the soft parts, or a destruction of the 
principal arteries of the limb; compound luxations of 
the larger joints, attended with extensive laceration, and 
contusion of the soft parts, particularly in hot weather; 
the limb being much shattered, or a part of it being 
torn off' by a ball or splinter; extensive mortification, 
affecting the extremity of a limb ; certain diseases, as 
a scrofulous knee joint, attended with great prostra- 
tion of strength, hectic fever, Sec ; the fungous ha:ma- 
totles affecting a limb ; caries of a joint, &c. &c. 

Q. How many kinds of fistula in ano are there ? 

A. Three: viz. 1st, the complete, opening external- 
ly, and also into the rectum ; 2d, the incomplete, with an 
external opening only ; 3d, the occult, having an open- 
ing in the gut, but none externally. 

Q. What is the cause of fistula in ano ? 
G 



74 SURGERY. 

A. In general, they arise from phlegmonous tumors, 
situated near the anus, which, being allowed lo sup- 
purate, form abscesses, which are prevented from heal- 
ing from the nature of the parts in which they are situ- 
ated, and consequently become fistulous. 

Q. What are the obstacles to the healing of ab- 
scesses seated in the vicinity of the anus? 

A- The matter not being able freely to discharge it- 
self, consequently keeps open the abscess, and excites 
an inflammation in its sides ; the faeces passing into the 
abscess when it opens in the intestine, and not being 
permitted to escape ; the external orifice of the abscess 
being closed, while the disease is continued within by 
the retained matter ; and lastly, the parts being pre- 
vented from remaining at rest, by the action of the 
sphincter ani muscle. 

Q. Define a caries. 

A. It consists in the ulceration of a bone ; the bone 
becomes >oft and loose, by the action of the absorbents ; 
it is surrounded by fungous granulations, which bleed 
on the slightest touch, and there is an offensive and 
dark coloured discharge of a serous nature from the 
pan. 

Q. At what part of the urethra do strictures general- 
ly take place ? 

A. All parts of the urethra are occasionally affected 
with strictures, but their seat is most frequently in the 
vicinity of the bulb. 

Q. How are fractures of both bones of the fore arm to 
be treated ? 

A. The arm being flexed, counter extension is to be 
made by an assistant grasping the arm near the elbow, 
while another makes extension by taking hold of the 
patient's hand. The surgeon, after placing the frac- 
tured extremities in contact, applies a roller from 
the fingers up to the elbow ; compresses being placed 
b.iween the bones, two splints, long enough to extend 
from above the elbow to the very extremities of the 
fingers, and somewhat broader than the arm, in order 



SURGERY. 75 

1.0 prevent the bandages from pressing the bones to- 
gether, are to be applied, one on each side of toe arm, 
the thumb being kept uppermost. The splints being- 
confined on by bringing down over them the roller, the 
arm is to be supported in a sling passed over the shoul- 
ders. 

Q. When, on opening a hernial sac, a large portion 
of indurated omentum is found in it, should it be re- 
turned into the abdomen ? 

A. No : the indurated portion is to be freely extir- 
pated, and the bleeding vessels, being secured by liga- 
tures, the remaining portion of the omentum is to be re- 
turned into the abdomen, keeping, however, the liga- 
tures opposite the mouth of the sac. 

Q. What are the causes producing haemorrhoids ? 

A. Whatever prevents a free return of blood from 
the hemorrhoidal vessels; as costiveness; tumors: 
pressing on the rectum ; pregnancy ; enlargement of 
the abdominal viscera ; prolapsus ani ; and also the 
habitual use of drastic purgatives. 

Q How is true aneurism to Be cured ? 

A By passing a ligature around a sound portion of 
the artery in which the aneurism is seated, and at a dis- 
tance from the tumor, so as completely to obliterate 
the cavity of the vessel. 

Q. When the principal artery in a limb is tied, how 
is the circulation carried on ? 

A. The anastomosing and collateral branches become 
enlarged, and convey a sufficiency of blood for the 
nourishment of the limb. 

Q. When, on opening a hernial sac, wc find the in- 
testine mortified, what are we to do ! 

A. We are directed, if the mortified portion be very 
small, and there is no opening in it, to return it at once 
into the abdomen ; when an opening exists in the mor- 
tified part, to stitch it up, and then return the intestine 
into the abdomen ; in both cases, keeping the part op- 
posite the mouth of the sac, by means of a stitch pass- 
li rough the mesentery, and through the mouth of 



SURGEHV 

the sac. If the whole cylinder of the intestine be mo; 
tified, it is to be allowed to remain in the sac; and it 
there be no opening in it, an incision is to be made into 
the mortified part, in order to give vent to the faces. 

Q. What are the causes of prolapsus ani ? 

A. A relaxation of the levator am muscle; habitual 
costiveness, occasioning violent strains at stool ; worms 
occupying the rectum ; the frequent use of drastic pur- 
gatives ; and hemorrhoidal affections'. 

Q. How is the disease to be treated ? 

A. The prolapsed parts are to be reduced as soon as 
possible, by the fingers. If an inflammation lias oc- 
curred in the protruded intestines, leeches are to be 
applied to the part; blood, if necessary, is to be drawn 
from the arm, and a cold poultice, with lead-water, is 
to be put on the swelling; all those circumstances 
whirl) favour the occurrence of the disease, are care- 
fully to be guarded against ; and the cure is to be com- 
pleted by a course of astringents and tonics. Dr. 
Fhysick recommends, in cases of prolapsus ani, a diet 
exclusively of rye mush and sugar or molasses. The 
patient to void his stools in a standing posture. By this 
mode ol treatment he has been enabled to affect a per- 
fect 'tire in several cases. 

Q What is the appearance of the sac, in femoral 
herma. upon dissection ? 

A. Beneath the skin and cellular membrane, we meet 
with c fascia, covering the sac, given off by the exter- 
nal oblique muscle, and much thickened ; under it lies 
the fascia propria, as it has been called, of the hernial 
sac. consisting of the union of a thin fascia, which 
naturally covers the femoral ring, and of the crural 
sheath; between this covering and the peritoneal sac, 
a quantity of adipose matter generally exists, which 
btii ii> removed, brings into view the proper sac of the 
hernia. 

Q How may a dislocation of the thigh upwards and 
backwards, be distinguished from a fracture of its 
neck ? 



SURGERY. 77 

Q. In fracture the leg is shortened ; the toes are in 
general turned inwards; the limb can be easily turned 
in many directions; and, by a particular motion, crepi- 
tus may be induced; when the fracture is reduced by 
extension and counter extension, and the extending 
force is discontinued, it immediately returns to the posi- 
tion in which it was before reduction. In the dislocation 
the toes are turned inwards, and cannot be turned out- 
wards ; a cavity is felt at the acetabulum, and a tumor 
is felt on the dorsum ilii, caused by the head of the 
bone ; and when the dislocation is reduced it remains 
so. 

Q. How is the operation for the relief of strangulated 
inguinal hernia to be performed ? 

A. The hair being shaved from the pubes, and 
the patient placed in a suitable situation, an inci- 
sion is to be made, commencing about an inch above 
the ring, and extending, if the hernial tumor be not 
very large, to the very bottom of the swelling, so that 
the skin and cellular membrane investing the sac will 
be cut through. If, by this incision, the external pudic 
artery, which crosses the upper part of the sac, be di- 
vided, it may be secured by a ligature before we pro- 
ceed further in the operation. A portion of the fascia, 
which is exposed by our first incision, is now to be 
raised with a pair of forceps, and divided so as to allow 
the introduction of a probe, on which the fascia is to 
be divided upwards to witbin an inch of the ring, and 
downwards to the bottom of the tumor. This opening 
through the fascia exposes the second covering of the 
hernial sac, viz.. the cremasti muscle, which is to be di- 
vided precisely in the same manner, when the sac will 
be exposed. The surgeon is next to pinch up, by a pair 
of forceps, some of the cellular membrane, which ad- 
heres to the anterior and inferior portion of the sac; when 
the sac is thus raised and separated from the intestine, he 
is to place the edge of the knife horizontally, and cau- 
tiously cut a small hole, just sufficient to admit the 
blunt end of a probe, or of a director, upon which the 
g2 



ra SURGER\ . 

sac is to be divided upwards to within an inch of the 
abdominal ring, and downwards to the bottom of the 
sac. The next thing to be attended to is the division 
of the stricture ; with this view, the finger is to be pass* 
ed into the nsrek of the sac, as far as the stricture, 
which will be found either at the ring, or about an inch 
and a half from this aperture, inclining obliquely up- 
wards and inwards, or else in the mouth of the sac. 
If the stricture be at the ring, a probe pointed bistoury 
must be conveyed over the front part of the sac into the 
ring, the finger in the sac serving as a director, and by 
it tin' stricture is to be divided in a direction directly 
upwards, opposite the middle of the sac, and to an ex- 
tent merely sufficient to allow the parts to be returned 
in'o the abdomen. By dividing the ring in this direc- 
tion, the epigastric artery is in no danger of being 
wounded, and the transverse tendinous fibres not being 
divided, the ring is but little weakened. The stricture 
being removed, the contents of the sac, if in a proper 
state, are to be returned into the abdomen. 

Q. What is meant by the term ectropium and entro- 
pium ? 

A. By ectropium is meant an eversion or unnatural 
turning out of the eye-lids, so as to expose the ball of 
the eye. By entropiwn, an inversion or turning in of 
the eye-iids, so that the cilia rub upon and irritate the 
ey*b«ll. 

Q. How are these affections to be treated? 

A. In ectropium we should either remove the lining of 
the everted lid, and afterwards support the latter in its 
natural place, or cut out an angular portion of the lid 
in the form of a letter V, and about one third of an inch 
broad at its base. The edges of the wound are then 
to be brought in contact, and secured so by a stitch. 
The most effectual cure for the inversion of the eye-lid, 
or enirojrium, is the excision, by means of sharp scissors, 
of t 1 • averted portion of the lid, as recommended by 
Dr. Dorsey, being careful in performing the operation, 
to avoid the pttneta lachrymalia. 



SURGERY. 79 

Q. What is meant by fistula lachrymalis r 
A. It consists in a stricture of the ductus ad nasutn, 
by whicli Uie tears arc prevented from passing into the 
nose, and being retained in tlie lachrymal sac, distend 
it, and produce an inflammation and suppuration of its 
cavity. The sac finally bursts, and a fistulous opening 
forms, through which the tears are discharged, and 
flow over the cheek. 

Q. What are the symptoms of the formation of a can- 
cer ? 

A. We are to suspect the formation of this disease 
whenever a glandular part becomes enlarged in size, 
and knotty, hard, and slightly sensible to the touch, 
and attended at a later period with sharp lancinating 
pains. The swelling proceeding, becomes at length 
surrounded by superficial varicose veins ; the integu- 
ments become discoloured and puckered; gradually 
the whole surface of the tumor assumes a purple shin- 
ing appearance, which it retains in general until ulcera- 
tion takes place. 

Q. How are dislocations of the thigh to be reduced : 
A. The patient being placed upon his back, counter 
extension is made by a band passed between the thighs, 
*o as to make pressure upon the tuber ischii of the sick- 
on which the luxation is seated; the ends of this band 
are to be firmly secured opposite the patient's shoulder, 
to a staple, or by assistants. Extension is to be made 
by a strong band being attached by means of a roller 
to the leg, just above the knee, which band is to be 
acted upon by a pulley, or a proper number of assist- 
ants. In oidcr to draw out the head of the bone from 
its present situation, and lift it to a level with the brim 
of the acetabulum, a bandage should be passed round 
the upper part of the dislocated thigh, and given to an 
assistant or assistants, while the pelvis is to be fixed 
by a strap passed around it, and secured opposite to the 
patient's sound side. These means are to be aided by 
bleeding, &c. in every case that will admit of it. 



SQ SURGERY. 

Q. How are transverse fractures of the patella to be 
treated ? 

A. The patient's leg is to be kept extended upon the 
thigh by means of a straight splint placed under the 
limb, long enough to extend from the heel to the but- 
tock, and secured on by a roller surrounding the whole 
limb, from the ancle to the upper part of the thigh ; when 
the bandage has arrived at the knee, the surgeon is to 
place the fragments of the fractured patella in contact, 
and after applying a compress above and below them, is 
to pass the bandage obliquely around the upper and low- 
er edges of the patella, and under the knee, in the form 
of a figure 8. To assist in keeping the fragments in 
contact, it has been proposed by Dr. Dorsey to nail on 
the splint, near its middle, and at the distance of six 
inches from each other, two bands of muslin, about 
one yard long ; the lower one of these is to be passed 
around the upper fragment of the patella, and the up- 
per around the lower fragment, and secured by knots. 

Q. How is the operation for fistula lachrymalis to be 
performed ? 

A. The abscess in the sac is to be opened by a sharp 
lancet, and its contents evacuated ; a silver probe is 
now to be passed, if possible, through the ductus ad 
nasum into the nose, and afterwards a conical piece of 
bougie, or a proper style, is to be passed into it, and 
worn for some time ; a superficial dressing being ap- 
plied to the sore. If, however, the ductus ad nasum 
be completely obliterated, we are to make a new open- 
ing into the nose, by perforating with a circular punch, 
that part of the os unguis which is immediately behind 
the lachrymal sac ; a piece horn of being passed up 
the nose to receive the end of the punch. The edges 
of the wound in the skin are to be dressed with ad- 
hesive plaster, so that it may heal as soon as possible. 

Q. What are the appearances of a cancerous ulcer ? 

A. A cancerous ulcer is irregular in its figure, and 
unequal on its surface ; the edges of the ulcer are hard, 
elevated, irregular, and extremely painful; the sur- 



S.URGEliN. 31 

ikin lias a livid aspect ; large excavations ex- 
ist in the bottom of the ulcer, partly produced by the 
ulcerative process, and partly by sloughing If the 
ulceration be extensive, it will be observed that while 
one portion is undergoing a sloughy process, another 
will be throwing up luxuriant granulations of a loose 
spongy texture. These changes appear in some cases 
to alternate with each other; and in their further pro- 
gress occasion considerable haemorrhages, by destroy- 
ing the coats of the vessels of the part The discharge 
from a cancerous ulcer is a very fetid matter, of a se- 
rous nature. 

Q. What is meant by unguis or pterygium ? 

A. It is an affection of the external covering of the 
eye-ball, consisting in an opaque red membrane pro- 
ceeding from the inner cant h lis of the eye, of a trian- 
gular figure, and caused by an enlargement of the ves- 
sels of the conjunctiva. 

Q How is it to be treated ? 

A. It is to be taken hold of by forceps, and dissect- 
ed completely off by a pair of curved scissors. 

Q. What is the treatment proper for a mamary ab- 
scess ? 

A. When the breast is attacked with inflammation, 
we should endeavour to prevent suppuration from en- 
suing by bleeding, both general and local ; by purging; 
by blisters to the part; and by confining the patient to 
an antiphlogistic regimen. When suppui ation has come 
on, and an abscess forms, it is to be opened with a 
lancet, and the matter perfectly evacuated. A soft 
bread and milk poultice will now be the proper appli- 
cation. 

Q. How is extirpation of the breast performed ? 

A The patient being seated, the arm of the affected 
side is to be elevated, and held off' from the body by an 
assistant, in order to render the skin tense. If the in- 
teguments of the breast be sound, a straight incision 
should be made through the skin and cellular mem- 
brane, and the tumor quickly dissected out. If any 



SURGERY. 

part of the integuments are to be removed with the 
breast, two incisions are to be made, so as to include 
the diseased skin ; and the breast is to be dissected out 
:is before. The bleeding vessels being secured with 
ligatures, the edges of the wound are to be drawn in 
contact, and dressed with adhesive strips. 

Q. What are the symptoms of a stone in the blad- 
der ? 

A. There is a dull uneasy sensation at the neck of 
the bladder, with an itching at the perineum and glans 
penis. Difficulty is experienced in voiding the urine ; 
the stream is frequently stopped by the stone falling 
over the orifice of the urethra, and when the bladder is 
nearly emptied, great pain is experienced by the blad- 
der contracting on the stone. The urine is sometimes 
loaded with mucus, at others limpid; it is sometimes 
tinged with blood, especially after a violent jolt of the 
body. A tenesmus sometimes attends. All these symp- 
toms are increased by exercise, and a violent exacer- 
bation of all of them will frequently come on without 
any evident cause, constituting what is called a fit of 
the stone. 

Q. What is the only certain criterion of the existence 
of a stone in the bladder ? 

A. Actually feeling it there with a sound. 

Q. How is a fistula in ano to be treated ? 

A. It is to be treated by laying open the simfs by 
cutting through its side, so that the fistula and the rec- 
tum shall form one cavity, with a free external open- 
ing. The edges of the incision are to be prevented from 
uniting, by introducing between a dossil of lint. 

Q. What are the muscles divided in the operation for 
lithotomy in the male ? 

A. The transversalis perinsei, a part of the accelera- 
tor urinx, and sometimes a portion of the levator ani. 

Q. How is the operation for the relief of strangulated 
femoral hernia to be performed ? 

A. The patient being laid upon his back on a proper 
'able, with his head and shoulders a little elevated, his 



SURGERY. 83 

legs as high as his knees hanging over the edge of the 
table, and his thighs somewhat bent upon the pelvis ; 
the parts having been previously shaved, and the blad- 
der emptied, an incision is to be made through the skin 
and cellular membrane, commencing an inch and 
a half above the crural arch, directly over the centre of 
the tumor, and extending downwards to its middle, be- 
low the arch. This incision is to be crossed by another, 
beginning at the inner side of the middle of the tumor, 
and extending across to the outer side of it ; the two 
incisions taken together being somewhat of the form of 
the letter T reversed. If the external pudic artery be 
opened, it is to be immediately secured by a ligature. 
This first incision exposes the superficial fascia, which 
being divided, the tumor becomes so far exposed, that 
the circumscribed form of the hernia may be distin- 
guished. The sac is however still covered by the fas 
cia propria, which is next to be divided longitudinally 
from the neck to the fundus of the sac. The hernial sac 
being now exposed, is to be next opened ; to do this, 
we are to pinch up a small part of it between the finger 
and thumb, to move it on the finger by which the intes 
tine is felt, and may be separated from the inner side 
of the sac ; and then to cut into the sac, placing the 
blade of the knife horizontally ; into this opening a di- 
rector is to be introduced, and the sac opened from its 
fundus to the crural sheath. We are next to divide the 
stricture ; for this purpose the finger is to be pushed 
gently into the sac ; a probe-pointed bistoury is then to be 
passed into the crural sheath, at the anterior part of the 
sac, and the sheath is to be cut as far as the anterior 
edge of Poupart's ligament- It, after this division, the 
intestines will not readily pass into the abdomen, the 
finger must be passed half an inch higher, and then 
the posterior edge of the crural arch, with the fascia 
that covers it, will be felt strongly compressing the 
mouth of the hernial sac ; to divide this the knife must 
be carried within the stricture, and then inclined ob- 
liquely inwards and upwards, at right angles with the 



«4 SURGERY. 

crural arch, and a cut is to be made in lhat direction 
sufficient to liberate the intestines from the stricture. 
The parts are now to be returned, if free from morufi- 
cation, and the external wound is to be dressed. 

Q- What are the cautions to be attended to in per- 
forming the operation oflithotomy ? 

A. 1st, to keep the handle of the staff' as nearly as 
possible at a right angle with the body ; 2d, to keep 
the gorget nearly at a right angle with the staff; 3d, 
id order to avoid wounding the internal pudic artery, 
to push the staff' as far as possible to the right side; 
and, 4th, never to push on the gorget while the patient 
is straining or bearing down : by not attending to this 
caution we are in danger of wounding the intestines 
and fundus of the bladder, by these being pushed down 
against the gorget in the act of straining. 

Q. How are false aneurisms to be treated ? 

A. A free incision is to be made into the cavity of 
the sac in order to expose the bleeding orifice, &c.; a 
ligature is then to be applied on the vessel above and 
below it. 

Q. Describe the operation for popliteal aneurism. 

A. The patient being laid upon his back, with a tour- 
niquet loosely applied on the upper part of the limb, an 
uciaton about four inches in length is to be made ob- 
liquely over the inner edge of the sartorious muscle, 
and at about the middle of the thigh. Having cut down 
to the muscle, and exposed the sheath of the vessels, 
this is to be cut into, and the artery laid bare. A strong 
double ligature is to be passed round the artery by 
means of a blunt needle ; the ligatures being divided 
from each other, they are to be firmly tied on the ves- 
sel at about an inch from each other, and the artery is 
to be divided between them. The edges of the wound 
are now to be drawn together, and secured by adhesive 
strips, the ligatures being left out at the angles. The 
patient is now to be put to bed with the'tourniquet 
loosely on the limb. 

Q. What are the symptoms of the hip disease ? 



SURGERY. 85 

A. 'flie accession of this disease is very insidious*; 
being sometimes unpreceded by any particular symp- 
toms that would excite the attention of either the pa- 
tient or the surgeon. In general, however, there is a 
weakness of the limb, a loss of appetite, and a disincli- 
nation to motion. There is now no pain in the part, 
though a pain is generally felt in the knee ; but at a la- 
ter period of the disease, pain is experienced in the vi- 
cinity of the hip joint, and the limb of the affected side 
appears longer than its fellow, occasioned by the pa- 
tient supporting his body entirely on the sound limb, 
and tilting his pelvis towards the diseased side ; pain is 
caused by examining the joint and by moving the thigh, 
and the buttock and hip lose their natural convexity. 
These symptoms continue until the suppuration takes 
place- 

Q. How is amputation at the shoulder joint per- 
formed ? 

A Dr Physiek directs the operation to be performed 
in the following manner: the patient being seated, and 
his arm elevated by an assistant, an incision is to be 
made through the skin and cellular membrane, to ex- 
tend around the arm, being even with the body on the 
lower part of the arm in the axila, and two and a 
half to three and a half inches below the acromion sca- 
pulae in front. The flap formed by this incision being 
dissected up, the muscles in front of the arm are to be 
divided even with the acromion from the internal to the 
external fold of the arm-pit; these folds are next to be 
divided. Pressure is now to be made, by an assistant 
standing behind the patient, on the subclavian artery, as 
it passes over the first rib ; the joint of the shoulder is 
then to be cut into, and the arm dislocated. It now 
only remains to divide the small portion of flesh con- 
taining the vessels, &c. which is next to be done ; and 
the vessels being secured as quickly as possible, the 
wound is to be cleansed, the flap drawn down over it, 
and the whole properly dressed. 

Q. How is the disease in the hip joint to be distin 
H 



S6 SURGERY. 

guished from an affection of the knee ; the early stage 
of the former being attended with a pain in the knee 
joint, apparently without any symptoms of disease at 
the hip ? 

A. In the hip disease, pressure in the vicinity of the 
acetabulum produces pain, as likewise does any motion 
at the hip, while the knee may be handled and moved 
freely without any pain whatever being induced. 

Q. What muscles are divided in amputating the 
thigh ? 

A. The biceps flexor cruris, semitendinosus, semi- 
membrinosus, gracilis, sartorius, vastus extcrnus and 
interims, rectus femoris, crurxus, and the long tendon 
of the adductor magnus. 

Q. In a case of caries, what would induce you to 
suppose the portion of bone to be loose ? 

A. When pressure on it with a probe occasions pain 
and a discharge of blood ; these symptoms being induc- 
ed by the loosened bone being pressed upon the tender 
granulations beneath. 

Q. What symptoms indicate the formation of an ab- 
scess in the hip joint? 

A. The pain is augmented and becomes fixed ; the 
parts surrounding the joint become tense, hot, red, and 
painful ; fever comes on attended with occasional ri- 
gors ; when pus has actually formed, all these symp- 
toms abate, and a fluctuating tumor is perceived at 
the joint. 

Q. How is the hip disease to be treated ? 

A. During the inflammatory stage the patient is to 
be confined to a state of perfect rest, and put on a low 
diet ; leeches are to be applied to the part, and after- 
wards a blister; the patient is at the same time to be 
purged actively by jalap and cream of tartar adminis- 
tered every two or three days. This practice of purg- 
ing was introduced by Dr. Physick, who directs it to be 
kept up for a considerable time. After suppuration has 
come on, the treatment is to be directed according to 
the existing symptoms. 



SURGERY. 87 

Q. How is amputation of the thigh performed ? 

A. Having placed the patient in a proper position, 
"with a tourniquet applied on the upper part of the limb, 
an assistant with both 1m hands grasps the thigh, and 
draws up the integuments so as to render them tense, 
while another holds the foot ; an incision is now to be 
made through the skin and cellular membrane, and ex- 
tending completely round the limb; a flap, composed 
of 'the skin and adipose membrane is now to be dissect- 
ed up with a scalpel, and turned back ; the muscles 
are next to be divided down to the bone, even with the 
doubled edge of the reverted flap ; a retractor or split 
piece of muslin is now to be put on, and held by an as- 
sistant so as to secure the muscles from injury by the 
teeth of the saw, and the bone is next to be sawed 
through The principal vessels being first secured, the 
tourniquet should be loosened, and the surface of the 
stump washed with warm water ; any considerable ves- 
sel which b now found to bleed must be secured. The 
flap being brought over the stump, a piece ot lint is to 
be interposed between its edges, to allow any pus that 
may form beneath the flap to escape; adhesive strips 
are next to be applied over the lips of the flap ; after* 
wards a piece of lint spread with cerate, and over all a 
pledget of tow. These are to be secured on by a roller 
passed several time* around the. thigh, crossed in op- 
posite directions over the stump, and then passed once 
or twice round the loins to prevent its slipping. The 
patient is now to be laid on a mattress, with the stump 
on a pillow, and secured from the pressure of the bed- 
clothes by a cradle. 

Q. How are setons introduced ? 

A. A seton needle, armed with a skein of silk or 
thuad oiled, is to be passed through a fold of the skin; 
the needle being removed, the silk or thread is to be 
allowed to remain. 

Q Describe the mode of amputating the leg. 

A. The patient being placed in a proper position, a 
tourniquet is to be applied on the thigh ; the leg and 



38 SURGERY. 

thigh being now secured by assistants, an incision is to 
be made through the skin and cellular membrane, about 
five inches below the knee in front, but to descend se- 
veral inches lower down behind, so as to save there a 
sufficient portion of the integuments to cover the stump. 
The flap being dissected loose is to be turned back, 
and the muscles divided even with the doubled edge 
down to the bone ; a catline is now to be introduced 
between the bones of the keg, so as to divide the inte- 
roseous ligament, &.c. A retractor having three slips 
is next to be applied, one of the slips passing between 
the bones, this being held by an assistant, so as to de- 
fend the muscles, the bones are to be divided with the 
saw ; any spicula remaining being removed with the 
bone-nippers, the arteries are to be secured by liga- 
tures, and the stump dressed as after amputation of the 
thrgh. 

Q. Why is the tourniquet placed above fixe elbow 
and knee, in operations on the fore arm and teg . ? 

A. Because there being but one cylindrical bone in 
those situations, the tourniquet ia enabled to pres3 
equally on all the vessels of the limb. 

Q. In what manner are the fingers and toes ampu- 
tated ? 

A. The skin being drawn back, an incision is to be 
made through it, extending round the finger or toe, a 
little beyond the joint ; a. flap large enough to cover 
the stump is next to be separated with a scalpel and 
turned back; the remaining parts are then to be divid- 
ed down to the joint, which being bent, the capsular 
ligament is to be cut through posteriorly, and after- 
wards one of the lateral ligaments ; the joint can now 
be dislocated, and the knife passed between the bones 
to separate the remaining ligaments, &c; the flap is 
now to be drawn over the stump, and secured by adhe- 
sive plaster, and a narrow roller passed around the 
£ncer. 



CHEMISTRY 

SECTION III. 

Examinations in Chemistry, &c. 

Question. By what methods do chemists investigate 
the properties of bodies ? 

Answer. By analysis and synthesis. 

Q. What do you understand by these terms ? 

A. By analysis, I understand the reduction of a com- 
pound body to its simple elements ; by synthesis, the 
recombination of these elements, so as again to form 
the substance we had decomposed in the first instance. 

Q. What do you mean by specific gravity ? 

A. I mean the comparative densities of bodies. 

Q. By what means do we ascertain the specific gra- 
vity of bodies heavier than water ? 

A. The weight of the substance in the air being 
known, weigh it immersed in pure water, it will now be 
found to have lost weight; divide, by this difference of 
weight, its original weight in air, and the quotient will 
be its specific gravity ; or, in other words, will show 
how many times heavier it is than an equal bulk of wa- 
ter, which is always taken as the standard. 

Q. What are we to understand by the affinity or at- 
traction of aggregation ? 

A. A union of particles of a similar nature, the mass 
not differing from the original particles in any thing 
excepting bulk, and perhaps form. 

Q. What is meant by single elective affinity ? 

V. Where a compound of two principles is decom- 
u 2 



*0 CHEMISTRY. 

posed by the addition of a third, one new compound 
being produced. 

Q. What is meant by double elective or complex 
affinity ? 

A. Where two compounds, consisting each of two 
principles, reciprocally decompose eacli other, and a 
change of principles takes place, forming two new 
compounds. 

Q. What do you mean by the term solution ? 

A. The disappearance of a solid in a fluid, the fluid 
still preserving its transparency. 

Q. What is meant by the affinity of composition, or 
chemical affinity ? 

A. The union of particles of a different nature, the 
new compound possessing different properties from the 
original particles. 

Q. Has the affinity of aggregation any effect upon the 
affinity of composition ? 

A. Yes; the latter is always in inverse ratio to the 
former. 

Q. Into how many rays is light divided by the spec- 
trum ! 

A. Into seven ; viz. red, orange, yellow, green, blue, 
indigo, and violet. 

Q. When the ball of the thermometer is removed 
entirely out of the confines of the red ray, but still in 
the line of the spectrum, what takes place ? 

A. The mercury is found to rise several degrees. 

Q. Is the same effect produced beyond the violet 
ray ? 

A. No ; but the invisible rays at this end of the spec- 
trum are found to have the power of blackening the 
muriates of mercury. 

Q. What is meant by caloric ? 

A. Caloric is a term made use of by modern chemists 
to distinguish the cause or matter of heat, from the sen- 
sation which this cause or matter produces. 

Q. How is the specific gravity of a body lighter lhan 
water ascertained ? 



CHEMISTRY. , 91 

A. Aftei' ascertaining its weight in air, attach to it a 
body of greater density, whose weight in water is 
known, and weigh them immersed together, the addi- 
tional substance will now be found to weigh less than 
it did when unattached ; add this difference of weight 
to the weight in air of the lighter body, and the amount 
will be the weight of a quantity of water equal in bulk 
with tVe latter ; this being compared with the absolute 
weight of the body under examination, will give its spe- 
cific gravity. 

Q. Does the same quantity of caloric exist in ice as 
in water at 32° > 

A. No; the latter contains 130° more than the for- 
mer, which, however, exists in a latent state. 

Q. Can this be proven by experiment ? 

A. Yes ; 1st, add to water at 162°, an equal quantity 
of ice at 32° ; when the ice has melted, the temperature 
of the whole will be only 32°, hence, 130° were ex- 
pended in rendering the ice fluid ; or, 2d, expose, in an 
equal degree of heat, equal quantities of water and of 
ice, both at 52°, the water will become heated to 162°, 
while the ice has merely been melted without acquiring 
any increase of temperature. 

Q. Do equal weights of different bodies, at the same 
temperature, contain equal quantities of caloric ? 

A. No ; every different body requires a different 
quantity of caloric to raise it to the same degree of sen- 
sible heat, as ascertained by the thermometer; hence 
we say, the capacity for heat is different in different 
bodies. 

Q. What is meant by a substance being precipitated? 

A. When a fluid, holding one or more principles in 
solution, lets one fall on the addition of some new body 
to which the combination has a greater affinity, the 
principle let fall is said to be precipitated by the newly 
added substance. 

Q. How is nitrogen gas procured ? 

A. By heating together in a retort, recent animal 
flesh and nitric acid ; cr by robbing the atmosphere 



92 CHEMISTRY. 

of its oxygen, by means of a sulphuret of potash or of 
iron moistened 

Q What are the properties of nitrogen gas ? 

A. It is an elastic, invisible fluid, incapable of sup- 
porting respiration, combustion, or vegetation ; it is in- 
soluble in water, and lighter than common air in the 
proportion ot 985 to 1000. 

Q. What are the different compounds of nitrogen and 
oxygen ; 

A. The nitric oxyde, nitrous gas, and the nitrous and 
nitric acids 

Q. What do you understand by the term crystalliza- 
tion ? 

A. That process by which the particles of salts, &c. 
arrange themselves in a regular and determinate form. 

Q. What law, with respect to crystallization, has the 
abbe Hauy experimentally demonstrated? 

A. That in every crystallized substance, whatever 
may be the difference of figure impressed upon it by mo- 
difying circumstances, there is, in all its crystals, a pri- 
mitive form, the nucleus, as it were, of the crystals, in- 
variable in each substance, and by various modifica- 
tions, which he points out, giving rise to the numerous 
secondary or actual existing forms. 

Q. What do you mean by the water of crystalliza- 
tion f 

A. It is that portion of water which combines with 
salts in the act of crystallization, and becomes a com- 
ponent part of the crystallized salt. 

Q. What is meant by the terms efflorescent and de- 
liquescent crystals ? 

A. By an efflorescent crystal is meant one, which, on 
exposure to the atmosphere, loses its water ot crystalli- 
zation, and falls into a dry powder ; unci by a deliques- 
cent crystal, one which attracts moisture from the air, 
and becomes fluid. 

Q. What do you mean by a simple element ? 

A. A substance which, in the present slate of che- 
mistry, is incapable of being decomposed. 



CHEMISTRY. 93 

Q. How many kinds of aggregative or sensible attrac- 
tion are there ? 

A. The attraction of gravitation, the attraction of 
electricity, and the attraction of magnetism. 

Q How is the oxygen gas procured ? 

A. It may be procured, 1st, by heat, from the red 
precipitate per se, and the other oxydes of mercury, or 
from the oxydes of lead ; 2d, by the action of the sul- 
phuric acid upon the black oxyde of manganese ; 3d, 
from the oxymuriate of potash ; 4th, by the decompo- 
sition of water by the agency of galvanism ; or, 5th, 
and which is the best mode when any quantity is to be 
obtained, by exposing nitrate of potash to heat ; the 
gas in this case becomes, towards the close of the pro- 
cess, considerably contaminated with nitrous gas, if we 
are not careful to stop the process the moment this gas 
begins to come over. 

Q. What are the properties of oxygen gas ? 

A. It is a colourless, elastic fluid, somewhat heavier 
than atmospheric air ; it is essential to the support of 
animal life, of combustion, and of vegetation, and has 
been considered as the acidifying principle, from whence 
it has derived its name, which signifies, to produce 
acidity. 

Q. What is meant by an oxyde ? 

A. A substance produced by the union of oxygen 
With a combustible basis, but not in a sufficient quantity 
to produce acidity. 

Q. Is a fluid capable of dissolving substances to an 
indefinite extent ? 

A. No; but only to a certain degree: when it will 
dissolve no more, it is said to be saturated. 

Q. When a menstruum has been saturated with one 
substance, is it incapable of dissolving another ? 

A. No ; thus water, when saturated with common 
salt, is capable of dissolving sugar, &c. 

Q- When a number of bodies, of different degrees of 
temperature, are placed in contact, what takes place ? 

A. They will acquire a common temperature. 



94 CHEMISTRY. 

Q. How many sources of" heat are there ? 

A. Five; the sun, combustion, mixture, friction, and 
percussion. 

Q. How is hydrogen pas procured ? 

A. By pouring diluted sulphuric acid upon iron 
filings, or upon zinc, and collecting the gas over water. 

Q What is the rationale of this process ? 

A. The iron Or line, when in contact with water, in 
conjunction with sulphuric acid, has a greater affinity 
foi oxygen than hydrogen has; the oxygen of the 
water, ; here fore, unites to it, forming an oxyilo of the 
metal, which is immediately dissolved by the acid, 
while the hydrogen of the water is set free. 

Q. What are the properties of hydrogen ? 

A. It is a Highly inflammable, invisible fluid ; when 
mixed witl) oxygen or atmospheric air, it detoi.ates on 
the application of a hurning body ; it extinguishes flame, 
and is hurtful to animal life, and is the lightest sub- 
stance with which we are acquainted! 

Q. What are the compounds of hydrogen ? 

A. With oxygen it forms water, and with nitrogen 
ammonia. 

Q. What are the leading properties of the alkalies ? 

A They have an acrid taste; change vegetable blues 
to a green ; are readily soluble in water, and form with 
the acids neutral salts. 

Q. How many alkalies are there ? 

A. Three; potash, soda, and ammonia. 

Q. Are the alkalies simple substances ? 

A. No: they would appear to be peculiar metals 
united to oxygen. 

Q. How may the decomposition of alkalies be effect- 
ed, and their metallic bases obtained ? 

A. Either by the agency of galvanism, or heating 
them in contact with iron filings in a gun-ban el; the 
iron attracts the oxygen of the alkali, and leaves the 
metal in a pure state. 

Q. Of what is water composed ; 



CHLMISTHV. 95 

A. Of about 80 parts oxygen and 15 of hydrogen. 

Q. How is this proved to be the composition of 
water ? 

A. By analysis and synthesis; pass water in the state 
of steam over red hot iron filings contained in a gun- 
barrel, the oxygen of the water will be absorbed by 
the iron, converting it into an oxyde, and the hydrogen 
will be liberated, and may be collected over water ; or, 
2d, by firing together, in a close vessel, proper propor- 
tions of oxygen and hydrogen, water will be produced. 

Q. What are the properties of acids ? 

A. They have a sour taste, change vegetable blues 
to a red, and by their union with alkalies, earths, and 
metal'ic oxydes, form sails. 

Q. How is sulphuric acid procured ? 

A. Hy burning, in close leaden chambers, sulphur 
combined with a small quantity of nitre ; the vapours 
produced are absorbed by a quantity of water placed 
in the bottom of the chamber, and the acid is after- 
wards reduced to its proper strength by distillation in a 
retort. 

Q. What is the product formed by the union of oxy- 
gen with a combustible basis ? 

A. Either an oxydc, an acid, or an alkali. 

Q. What is the composition of atmospheric air? 

A. Twenty-one per cent, of oxygen to seventy-nine 
of azote, by measure. 

Q. How would you procure ammoniacal gas ? 

A. By adding together proper proportions of muriate 
of ammonia and quick lime, and exposing them to a 
gentle heat ; a decomposition takes place, the lime 
seizes upon the muriatic acid, forming muriate of lime, 
while the ammoniacal gas is given off, and may be col- 
lected over mercury. 

Q. What are the properties of sulphuric acid > 

A. It is a very ponderous, corrosive fluid, destitute 
of either colour or smell, and has a strong acid taste ; 
when poured from one vessel into another, it runs in 
striae like oil. It has a great affinity for water, on com- 



^tx CHEMISTRY. 

bining with which, a considerable degree of heat is 
evolved. Sulphuric acid unites with the earths, alka- 
lies, and metallic oxydes, forming with them salts, de- 
lominated sulphates. 

Q What are the properties of ammonia ? 

A. Besides all the properties of the other alkalies, 
it possesses great volatility, and a very pungent smell ; 
when pure.it exists in the state of a gas. 

Q. Is ammonia a simple substance ? 

A. No ; it is a compound of nitrogen and hydrogen. 

Q. How do you procure muriatic acid ? 

A. Add together muriate of soda and sulphuric acid, 
and expose them to heat in a retort, the sulphuric acid 
will decompose the muriate of soda, and, uniting with 
the alkali, form sulphate of soda, while the acid passes 
over ma gaseous state. 

Q. What are the characteristics of the sulphates ? 

A. They are insoluble in alcohol ; their solutions 
are decomposed by a solution of barytes ; they be- 
come converted into sulphurets by ignited charcoal at 
high temperatures, but are undecomposable by heat 
alone. 

Q. How is the oxymuriatic acid procured ? 

A. By adding together, in a retort, muriate of soda, 
black oxyde of manganese, and sulphuric acid, and 
exposing to a gentle heat. 

Q. What is Mr. Davy's opinion with respect to the 
muriatic and oxymuriatic acids ? 

A. He supposed the oxymuriatic acid to be a simple 
substance, which he calls chlorine, and which, in union 
with hydrogen, he supposes to form muriatic acid. 

Q. What do you mean by latent heat ? 

A. That portion of heat which is required to main- 
tain the fluid or vaporous state of a body ; but which 
does not affect the thermometer. 

Q. What is the meaning of the term specific heat? 

A. By specific heat is meant that quantity of heat 
which any particular body requires to raise it to any 
given degree of temperature as indicated by the ther- 
mometer, and which differs in every different bodv. 



CHEMISTRY. 97 

Q. What is sulphur ? 

A. It is a brittle, inflammable substance, found prin- 
cipally in the mineral kingdom ; it is of a yellow co- 
lour, of a suffocating smell when heated, and becomes 
electric upon being rubbed. 

Q. What are its principal compounds ? 

A. Sulphurous and sulphuric acids ; sulphurated hy- 
drogen and the different sulphurets of the metals, 
earths, and alkalies. 

Q. What do you mean by an earth ? 

A. An inodorous, uninflammable, brittle substance, 
very sparingly soluble in water, and when pure of a 
white colour ; its specific gravity does not exceed 5. 

Q. Are earths simple substances ? 

A. No; they are in all probability metallic oxydes. 

Q. What are the leading properties of barytes ? 

A. It is a very ponderous earth, of a highly caustic 
taste ; it changes vegetable blues green ; it is poison 
ous, and when pure readily absorbs water. 

Q. What is the test of the muriatic acid ? 

A. The nitrate of silver, which produces with it a 
white precipitate, the muriate of silver. 

Q. What is the test of sulphuric acid ? 

A. The muriate of barytes, producing with it a white 
precipitate, which is the sulphate of barytes. 

Q. What effect has oxymuriatic acid upon vegetable 
colours ? 

A. It destroys them, and hence its great value in the 
process of bleaching. 

Q. In the formation of an acid, does the oxygen en- 
ter in combination with the basis in one proportion 
only ? 

A. No ; in most cases it enters in combination with 
the basis in two proportions, forming acids of different 
degrees of strength. 

Q. How is this difference distinguished in chemical 
nomenclature ? 

A. The name of the acid with the lowest proportion 
I 



98 ' CHEMISTRY. 

of oxygen terminates in ous, tliat with the highest pro- 
portion, in re. 

Q. What do yon mean by a salt ? 

A. It is a substance formed by the union of an acid 
with an alkali, an earth, or a metal, and is characterized 
by its sapidity, ready solubility in water, incombustibili- 
ty, and Us capability of assuming a regular form, or of 
crystallizing. 

Q What are the properties of muriatic acid ? 

A. Muriatic acid, in a gaseous stale, is invisible like 
air; has a pungent, suffocating smell, and is indecom- 
posable by art. With water it forms liquid muriatic 
acid, which preserves the smell of the gas, and gives 
out a vapour, which fumes when exposed to the air. It 
disengages the carbonic, phosphoric, and sulphurous 
acids from all their combinations, but is itself expelled 
by the sulphuric ; with various bases, it forms salts 
called muriates. 

Q, Mow arc pure potash and soda obtained > 

A. Pure potash is obtained by lixiviation from the 
ashes of land vegetables; pure lime is added to extract 
the carbonic acid, and the liquor being evaporated 
nearly to dryness, is digested in alcohol, which dissolves 
nothing but the pure alkali; the alcohol is again to be 
separated by distillation. Soda is obtained by the same 
process, but only from plants growing close on the sea 
shore, &.C. 

Q. What is the reason that when I apply my hand to 
iron and to wood at the same temperature, the former 
feels so much colder than the latter ? 

A. Because the iron is a much better conductor of 
caloric than the wood, and consequently more rapidly 
robs tht hand of its heat. 

Q. What is meant by a gas ? 

A. Jt is a permanently elastic, xriform fluid, trans- 
parent, elastic, ponderable, invisible, and not condensi- 
ble into a solid or fluid slate by any degree of cold 
hitherto known. 



CHEMISTRY. 99 

U. 1m what substance are we presented with a speci 
"Ynen of pure carbon ? 

A |n the diamond. 

Q. What is charcoal ? 

A. It is an bxyde of carbon. 

Q. What cfl'ect has charcoal upon the putrefactive 
fermentation ? 

A. It retards or suspends it. 

CI. What peculiar property has charcoal with respect 
to the teases when immersed in them ? 

A. It absorbs them unchanged. 

Q. What are the properties of oxygenated muriatic 
acid ! 

A. When in the form of gas, it possesses a peculiar 
pungent and suffocating odour ; it is perfectly irrespir- 
able, but will in many cases support combustion ; ab- 
sorbed by water it forms liquid oxymuriatic acid : this 
acid discharges vegetable colours, oxydizes all the me- 
tals, and is the only acid capable of dissolving &o\d and 
platina With various bases it forms salts called hyper- 
oxygeuiied muriates. 

Q. How is the combination of a combustible with a 
metal, an earth, or an alkali, designated ? 

A. By the name of the combustible terminating in 
nret ; thus the combination of carbon with iron is called 
a carburet of iron, and of sulphur with lime, a sulphuref 
of lime. 

Q. How are the salts, formed by an acid of the high- 
est grade of oxydation, distinguished from those formed 
by an acid in the lower grade of oxydation ? 

A. The former terminate in ate, the latter inite ; thus, 
the salt formed by the union of sulphuric acid with 
lime, is called sutphnte of lime, while that formed by 
the sulphurous acid is denominated the sulphite of 
lime. 

Q. What are the properties of the muriates ? 

A. When acted upon by the sulphuric acid, they 
yield a white vapour, which is muriatic acid, and when 
by the nitric, oxygenated muriatic acid gas, with con- 



100 CHEMISTRY. 

siderable effervescence ; they are decomposed by a so- 
lution of the nitrate of silver, and are volatilized at 
high temperatures without decomposition. 

Q. How would you distinguish the sulphate of soda 
from the sulphate of magnesia ? 

A. I would add a solution of potash to a solution of 
each of the salts ; with the sulphate of magnesia there 
would be white precipitate, with the sulphate of soda 
none. 

Q What is alum, chemically speaking ? 

A. It is a sulphate of alumine and potash. 

Q How is the nitric acid procured ? 

A. By adding together, in a retort, nitrate of potash 
and sulphuric acid ; the nitric acid, on the application 
of heat, passes over into the receiver, and a sulphate of 
potash remains behind. 

Q. What are the properties of nitric acid ? 

A. It is a fluid, clear and colourless like water ; its 
smell is acrid ; and its taste exceedingly acid ; and its 
action on animal substances very corrosive; it has the 
property of permanently staining the skin yellow ; it has 
a great affinity for water ; is capable of oxydizing most 
of the metals, and with various bases forms salts named 
nitrates. 

Q. What is phosphorus ? 

A. It is a highly inflammable substance, of a yellow- 
ish colour, transparent, and of the consistency of wax ; 
it is luminous in the dark at common temperatures, and 
is soluble in oils. 

Q. What are the principal compounds of phospho- 
rus ? 

A. With oxygen, constituting the phosphorous and 
phosphoric acids; with hydrogen, forming phosphurelted 
hydrogen ; and with the metals, earths, and alkalies, 
forming phosphurets. 

Q What are the distinguishing characters of the oxy- 
muriates or hyper-oxygenized muriates ? 

A. They are distinguished by yielding oxygen gas 
when heated, and thus becoming converted into muri 



CHEMISTRY. 101 

ates. They detonate violently by friction and percussion 
with the easily inflammable bodies. 

Q. What are the different compounds of carbon ? 

A. Carbonic acid gas, carbonic oxyde, and carburet- 
ted hydrogen. 

Q. What are the leading properties of the sulphu- 
rels ? 

A- They are perfectly devoid of odour when dry, but 
exhale, when moistened, a smell resembling rotten eggs; 
they stain the skin black, and change vegetable blues 
to a green. 

Q. What is the first or most obvious effect produced 
on all bodies by heat ? 

A. A dilatation or increase in the bulk of the body. 

Q. How may nitrous oxyde be procured ? 

A. By exposing to heat, in a retort, the nitrate of am- 
monia. 

Q. What is the rationale of this operation ? 

A. The nitrate of ammonia is composed of nitric acid 
and ammonia; the nitric acid consists of nitrous gas 
and oxygen, and the ammonia of nitrogen and hydro- 
gen ; at a high temperature a decomposition takes 
place, when the nitrous gas of the decomposed acid 
combines with an additional dose of nitrogen, afforded 
it by the ammonia, and forms the nitrous oxyde, while 
the oxygen of the acid unites with the hydrogen of the 
ammonia to form water. 

Q. What are the properties of the nitrous oxyde? 

A It is heavier than atmospheric air, possesses :t 
sweet taste, and a slight but agreeable odour ; it is not 
manifestly acid. It is absorbed by water, and when 
again given out possesses all the former characters ; its 
most remarkable property is its highly exhilarating ef- 
fects upon the system, when respired. 

Q Are there any exceptions to the general law that 
all bodies contract on cooling? 

A. Yes ; water, when cooled down to the freezing 
point, instead of contracting on the further abstraction 
i 2 



lOt CHEMISTRY. 

of caloric, actually expands ; fused iron and some other 
metals also expand on becoming cool. 

Q. How is phosphoric acid procured ? 

A. It may be obtained either, 1st, by the slow com- 
bustion of phosphorus ; 2d, from calcined bones, which 
consist of the phosphate of lime, by the aid of the sul- 
phuric acid ; or, 3d, by the action of nitric acid upon 
phosphorus. 

Q. What are the properties of lime ? 

A. When pure, it is perfectly white, brittle, and in- 
fusible ; it has a hot, caustic taste ; corrodes animal and 
vegetable substances ; changes vegetable blues, green ; 
and upon the application of water it heats and falls into 
powder, absorbing near one-fourth its weight of the 
water, in which state it is called a hydrate of lime. 

Q. What are the distinguishing properties of the ni- 
; : rates ? 

A. They yield oxygen and nitrous gases by the action 
of heat; they give out a yellowish vapour, which is ni- 
trous acid ; when acted upon by the sulphuric acid, 
and when mixed with combustible substances, at a red 
heat, they inflame and detonate. 

Q. How is the carbonic acid gas to be procured ? 

A. By the action of sulphuric acid upon the carbonate 
of lime, or by burning charcoal in oxygen gas. 

Q. What are its properties > 

A. IL is about one-third heavier than atmospheric 
air ; has a penetrating odour and an acid taste ; it ex- 
tinguishes flame, and is destructive of animal life; it is 
readily absorbed by water, to which it communicates a 
sparkling appearance and a pungent acid taste. 

Q. What is the test of the presence of lime ? 

A. The oxylate of potash, which produces with it a 
while precipitate, the oxylate of lime. 

Q. What are the distinguishing properties of the me- 
tals ? 

A. Metals are distinguished by their opacity, the 
great specific gravity of a majority of them, and their 



CHEMISTRY. 103 

peculiar brilliancy ; tliey are the best conductors of 
heat and of electricity. 

Q. What other properties arc possessed by a part of 
the metals ? 

A. Ductility, or the capability of being drawn into 
wire ; and malleability, or the property of being beaten 
into plates or leaves. 

Q. If through a portion of lime-water T pass a stream 
of carbonic acid gas, what will be the effect ? 

A. The water will become cloudy, occasioned b' the 
precipitation of the lime. 

Q. If after all the lime is precipitated, I still continue 
to add more carbonic acid, what will be the effect ? 

A The water will resume its transparency. 

Q. How do you explain these different effects ? 

A. Carbonate of lime, which is formed in the first in- 
stance, is insoluble in water, and of course precipitates ; 
but on adding an excess of carbonic acid, as in the lat- 
ter case, it again becomes soluble 

Q. What do you mean by an alloy ? 

A. The union of two different metals. 

Q. How would you procure sulphuretted hydrogen ? 

A. By pouring a diluted acid upon an alkaline sul- 
phuret. 

Q. What are its properties ? 

A. It possesses a very feet id smell; is irrespirable ; and 
burns with oxygen, without explosion, depositing sul- 
phur; it blackens the white metals. is absorbed by 
water, and renders vegetable blues red 

Q. What are the properties of magnesia ? 

A. It is very light, of a white colour, insipid, and al- 
most entirely insoluble in water ; it slightly changes ve- 
getable blues to a green, and forms soluble, salts of a 
bitter taste with most of the acids. 

Q How do you procure phosphuretted Indrogen ga*r 

A. By adding together, in a retort, pure ca> a.i.' pot- 
ash and phosphorus ; filling the retort with, aid im- 
mersing its beak in, warm water, and applying neat. 

Q. What is the rationale of this process P 



104 CHEMlSTin. 

A. At a certain temperature, the alkali decompose 
tin- water, the hydrogen of which unites with one por- 
tion ol the phosphorus to form phosphuretted hydrogen, 
while the oxygen of the water unites with another por- 
tion of the phosphorus, and forms phosphoric acid. 

Q. What are the properties of phosphuretted hydro- 
gen gas > 

A. It is the most inflammable substance we are ac- 
quainted with, taking fire the moment it is brought in 
conuict with the atmosphere ; mixed with oxygen, it 
burns with great violence. 

Q. Do the metals unite with acids ? 

A. They do in the state of oxydes, but not in their 
metallic stale. 

Q. How is carburetted hydrogen gas obtained ? 

A By one or other of the. following methods : 1st. 
The vapour of water being brought in contact with 
charcoal at a red heat, the oxygen of the former com- 
bines with a portion of carbon, forming carbonic acid. 
The hydrogen of the water, at the moment of its libera- 
tion, unites with another portion of the charcoal, con- 
stituting rurbureiud hydrogen, from which the car- 
bonic acid may be separated by agitation in lime water. 
2d. By agitating the stagnant mud of pools or ditches, 
bubbles of the gas will ascend to the surface. 3d. By 
distilling in an iron retort, sea coal or tar, and washing 
the product in water. 4th. By conducting the steam of 
ether or alcohol through an ignited porcelain tube, and 
collecting and washing the product in lime water. 5lh. 
By distilling in a glass retort, with a gentle heat, three 
parts of concentrated sulphuric acid, and one of alco- 
hol, and collecting the result over water. 

Q. What is its most important property ? 

A. That of burning with a strong, compact, very lu- 
minous flame, in consequence of which, it has been ap- 
plied to the purpose of lighting houses, cities, &c. 

Q. When charcoal in fine powder, phosphorus, or 
the metals, in minute division, are introduced into oxy- 
muriatic acid gas, what is the effect '. 



CHEMISTRY. 105 

\. iliey become ignited. 

> l What are the properties of silex ? 

A. It is of a white colour, of a rough and harsh feel, 
and soluble by the fixed alkalies; it is incapable of 
fusion alone. 

Q. What is the most important compound of silex ? 

A. With potash, forming glass. 

Q. How could you distinguish a solution ofplatina 
from one of gold > 

A. By adding to each a solution of the muriate of 
ammonia, there would be with the platina a precipi- 
tate, but not any with the gold. 

Q. If to a metallic solution I were to add a solution 
of the muriate of tin, and a purple precipitate ensue, 
what metal would you conclude to be present ? 

A. Gold. 

Q. What is this purple precipitate ? 

A. It is an oxyde of gold and of tin, known by the 
name of the purple powder of cassius. 

Q. Does the metallic basis of potash, named by Mr. 
Davy pottasium, unite with mercury? 

A. Yes. 

Q. What is particularly to be observed of the metals 
in this combination ? 

A. The power of the mercury to amalgamate with 
the other metals is increased, and the avidity of the 
pottasium for oxygen is augmented. 

Q What are the properties of alumine ? 

A. When pure, it is white, of a smooth, unctuous 
feel, and it strongly adheres to the tongue ; with water 
it forms a soft tenacious mass, capable of being mould- 
ed into different shapes. It contracts greatly by heat, 
and acquires a flinty hardness. It combines with most 
of the acids, and forms salts of a sweetish, stiptic taste. 

Q To what important purpose has this earth been 
applied by Mr. Wedgewood ? 

A. To the admeasurement of high degrees of tem- 
perature. This gentleman found the volume of a brick 
of the clay to contract in proportion to the degree of 



100 CHEMISTRY. 

lieat to vvliich it was exposed ; this contraction he 
measures by a scale of a particular construction, each 
degree of which is equal to 150° of Fahrenheit. 

Q. How is the fluoric arid obtained? 

A. By ttie action of sulphuric acid upon powdered 
filiate of lime- 

Q. What are the properties of fluoric acid ? 

A. It is an invisible, elastic pas, heavier than atmo- 
spheric air, possessing a peculiar suffocating odour, re- 
sembling- that of the muriatic acid. It is rapidly ab- 
sorbed by water, and has the property of acting upon 
silt , and consequently corrodes glass. 

Q. In how many different ways may a metal be oxy- 
dized ? 

A Either by exposure to the atmosphere, by heat- 
ing it in contact with the air, by combustion in oxygen 
gas, b\ galvanism, by the decomposition of water, or 
by transferring to it oxygen from another oxyde. 

Q. la a metal capable of union with only one propor- 
tion of ox\gen P 

A. Most metals are capable of union with two or 
more proportions of oxygen, forming different oxydes. 

Q. How are these different oxydes denominated ? 

A. If there be but two oxydes of a metal, the one 
containing the lowest proportion of oxygen is denomi- 
nated a protoxyde, the other a peroxide. If there be 
more than two, the second is denominated a deutox- 
yde, the third a tritoxyde, &c. 

Q How may prussic acid be obtained ? 

A. By boiling together, in a glass matrass, two parts 
pulverised prussian blue, one of red oxyde of mercury, 
and six of water; the boiling is to be continued for half 
an hour, during which time the matrass is to be. fre- 
quently' shook ; afterwards, the liquor thus ob'ained is 
to be faltered, and then poured into a bottle containing 
abou'. an ounce of iron filings ; three ounces concen- 
trated sulphuric acid are now to be added, and the 
whole shook together for some minutes ; after being 
allowed to settle, it is to be placed in a retort, the re- 



CHEMISTRY. 107 

ceiver of which contains a little distilled water, on a 
sand bath ; on the application of a gentle heat, the 
piussic acid will pass into the receiver ; and when about 
one-fourth of the liquor has come over, the operation is 
to b e suspended. The prussic acid may also be obtain- 
ed by supersaturating the prussate of potash with sul- 
phuric acid, and frequently distilling. 

Q What is its composition ? 

A. Carbon, hydrogen, and oxygen. 

Q What are its properties ? 

A. It is a highly volatile, colourless fluid, possessed 
of a strong odour, resembling that of peach blossoms, 
or of bitter almonds bruised. It has a sweetish but 
acrid taste ; is highly poisonous, and does not affect the 
moat delicate vegetable blues. 

Q. What is tannin ? 

A. It is a peculiar principle, obtained from vegeta- 
bles of an astringent nature, particularly from galls. 
It is of a yellowish colour, and of a resinous appear- 
ance. It has a bitter astringent taste, is soluble in hot 
water, anil in alcohol. A solution of tannin, on being 
added to u solution of animal gelatine, converts it into a 
tough, elastic substance, resembling leather. It is by 
the agency of this principle, that the process of tanning 
is effected. 

Q. What is meant by the chromic acid ? 

A. Chromic acid is chromium combined with oxygen. 
It exists in the form of an orange, coloured powder. 

Q By what acids is gold acted upon ? 

A. By the nitro-muriatic and oxymuriatic only. 

Q. Can the gold be precipitated from this solution 
in a metallic state ? 

A. Yes : by carbon, by hydrogen, sulphuretted hy- 
drogtn, and (he green sulphate of iron. 

Q. What is gum ? 

A. It is a vegetable substance, destitute of either 
taste or smell, soluble in water, insoluble m alcohol, 
and coagulable by the weaker acids, and metallic so- 



•108 CHEMISTRY. 

lutions ; it is convertible into oxalic acid by tlie nitric, 
and into citric by the muriatic. 

Q. What do you mean by lunar caustic ? 

A. The fused nitrate of silver. 

Q How is the gallic acid obtained ? 

A By evaporating to a dry state a watery solution of 
galls, dissolving the mass in alcohol, and straining. 
The alcohol is to be again separated by distillation, and 
the substance remaining is to be evaporated to dryness, 
mixed with clean sand, and sublimed. 

Q. What are its properties ? 

A. It has an acid astringent taste, reddens vegetable 
blues, is inflammable, and precipitates iron of a deep 
black colour ; and hence its use in the formation of 
writing ink, aud the black dyes. 

Q. What is the test of silver ? 

A. The muriatic acid, which produces with it a white 
precipitate. 

Q. How would you distinguish the nitrate from the 
sulphate of copper? 

A. By adding to a solution of both a solution of the 
acetate of lead, with the nitrate there will be a white 
precipitate thrown down, but with the sulphate none. 

Q. What are the tests of arsenic ? 

A. The presence of arsenic may be detected, 1st 
by adding to a solution of the suspected substance, a 
solution of the hydro-sulphuret of potash ; if any arse- 
nic be present, a precipitate will be instantly thrown 
down, of a golden yellow colour. 2d. By adding to the 
solution a drop or two of a weak solution of carbonate 
of potash, and afterwards a few drops of a solution of 
sulphate of copper; the presence of arsenic will be 
shewn by a precipitate of a yellowish green colour, 
known by the name of Scheele's green. 3d. By mix- 
ing the suspected substance with three times its weight 
of the black flux, and exposing it to a red heat for 
some time in a glass tube coated with clay ; if any ar- 
senic be present, it will now be found in the form of a 
brilliant metallic coating on the inner surface of the 



CHEMISTRY. .109' 

glass. 4thr. By placing a small portion of the suspect- 
ed substance with half its bulk ot powdered charcoal, 
and a drop or two of oil, between two plates of polished 
copper, which are to be tightly bound together with 
wire, and exposed to a red heat; the presence of arse- 
nic will cause a permanent white stain on the copper. 
5th. By throwing the metallic substance obtained by 
experiment third on a heated iron ; if it be arsenic, a 
dense bluish smoke will arise, and. a strong smell of 
garlic will be perceived. 6th. Mr. Hume has proposed 
the following test. Let the fluid suspected to contain 
arsenic be filtered, then let the end of a glass rod, wet- 
ted with a solution of pure ammonia, be brought ia 
contact with the fluid, and at the same time, let the end 
of another clean rod, similarly wetted with a solution 
of the nitrate of silver, be immersed in the mixture; if 
the least portion of arsenic be present, a precipitate of 
a bright yellow colour, inclining to orange, will appeal- 
at the point of contact, and will readily fall to the bot- 
tom of the vessel. As this precipitate is soluble in am- 
monia, care must be taken not to add an excess of that 
alkali. 

Q. How many sulphaies of iron are there? 

A. There are two ; the red and the green sulphates, 
or in other words, the sulphates of the red and of the 
black oxyde, or of the protoxide and peroxyde of iron. 

Q. What is the malic acid ! 

A. It is an acid obtained from the juice of apples, 
plums, barberries, elder-berries, and gooseberries, and 
also the common house leek, in which it exists ready 
formed. It is a very acid, reddish coloured liquid, and 
is composed of oxygen, hydrogen, and carbon. 

Q. What is blue vitriol ? 

A. It is a supersulphate of the black oxyde of cop- 
per. 

Q. What is the test of copper? 

A. Ammonia, which produces with it a deep blue 
precipitate, which is the ammonuret of copper. 
K 



110 GHBMISTBY 

Q. Wlut are the elhiops mineral ami cinnabar, 
chemically speaking' 

A Thev are a black and a red sulphuret of mercury, 
differing in the proportion of sulphur entering into 
each. 

Q. What is steel? 

A. It is a carburet of iron. 

Q. What is the sebacicacid > 

A. It is an acid. produced from hog's lard, by distil- 
ling the. lard, and adding to the product acetite of lead, 
a precipitate will be formed, which is the sebate of 
lead ; this being decomposed by the addition of sul- 
phuric acid, a substance resembling fat will appear on 
the surface; this is to be collected, dissolved in boiling 
water, and allowed to cool and crystallize, and is the se- 
bacic acid. 

Q What are the tests of iron ? 

A Either an infusion of galls, which forms with it a 
black precipitate, or the prussiate of potash, which pre- 
cipitates it of a deep blue colour. 

Q What do you mean by a resin ? 

A. It is a peculiar vegetable principle, insoluble in 
water, but soluble in alcohol and in oils : it is very in- 
flammable, and yields much sool during combustion ; 
at a heat lower than that of boiling water, it melts into 
an oily fluid, but becomes again solid on cooling. 

Q. How do we procure the citric acid ? 

A. To any quantity of boiling lemon juice, add, gra- 
dually, pure carbonate of lime (prepared chalk) in 
powder, until the effervescence ceases ; separate the 
white precipitate formed during this process, by strain- 
ing, and washing it with water, until this fluid passes 
tasteless through the strainer ; add to the washed preci- 
pitate, diluted sulphuric acid, and|boil the whole for half 
an hour, frequently stirring; strain and evaporate the 
fluid thus procured, until it becomes of the consistency 
of syrup, and set it by to crystallize. These crystals', 
which are the citric acid, may be further purified by 
repeated solution and crystallization. 



OUKMISTUY. Ill 

i±. What is the rationale of this process ? 

A. The citric acid contained in the lemon juice en- 
ters into combination with the lime of the chalk, and 
forms the insoluble citrate of lime, while the carbonic 
acid gas escapes ; on adding the sulphuric acid, it, 
from its greater affinity to the lime, unites with it in 
the form of sulphate of lime, which is precipitated, 
while the citric acid is left in a free slate. 

Q. What are the distinguishing properties of albumen 
and gelatine ? 

A Albumen is an insipid substance contained in the 
blood of animals, and constituting the chief part of the 
while of eggs. On exposure to heat, and by the action 
of the mineral acids, it is converted into a firm sub- 
stance, which is insoluble. Albumen, when dried, be- 
comes brittle and semi-transparent, like horn, and is 
again soluble in water. Gelatine is obtained from the 
tendons, cartilages, ligaments, ike. of animals, by^ioil- 
ing ; it is insipid, and destitute of smell ; soluble in hot 
water, but insoluble in alcohol; on being dried it be- 
comes hard, constituting glue. Gelatine is precipitated 
from its solution by tannin. 

Q. How may steel be distinguished from iron by a 
chemical test ? 

A. By dropping nitric acid upon a polished plate of 
iron, a white stain will be left, but on steel a black one. 

Q. What is the suberic acid ! 

A. It is an acid obtained from cork, by means of the 
nitric acid. It exists in the form of a powder, and is 
not crystallizable. 

Q. What do you mean by fermentation ? 

A. I mean that spontaneous intestine change which 
animal and vegetable substances undergo, when placed 
finder particular circumstances, during which the com- 
ponent principles of the substance enter into new com- 
binations. 

Q. What is the red lead of commerce ? 

A. It is a deutoxide of lead, procured by heat. 

Q How mav benzoic acid be procured ? 



1.12 t;HEMlSTR\ 

A. By repeatedly boiling together four parts of ben 
zoin, one of lime, and about twenty of water, filtering 
the solution, and adding to it sulphuric or muriatic 
acid, until no further precipitate takes place. The pre 
cipitate obtained is the benzoic acid- It may be puri- 
fied by repeated solutions, filtration, and crystallization 
Benzoic acid may also be obtained by simple sublima- 
tion. 

Q. What are its properties ? 

A. It exists in the form of fine white crystals. It has 
a pungent, vivid taste, and when pure, is totally desti- 
tute of odour. It is sparingly soluble in cold, but abun- 
dantly so in warm water, and also in alcohol, sulphuric* 
nitric, and acetic acids, from which it may be again 
separated by the admixture of water. It volatilizes at 
a moderate heat, and detonates with nitre. 

Q. What circumstances are necessary for the process 
of fermentation to take place ? 

A. A certain degree of fluidity in the substance; a 
degree of heat from 55° to 80° Fahrenheit, and the con- 
tact of the atmospheric air. 

Q In what form is arsenic found in the shops ? 

A. In the form of arsenous acid, which is a protoxyde 
of the metal 

Q How is the camphoric acid procured ? 

A. By distilling in a retort eight parts of nitric acid, 
with one of camphor; repeating the distillation three 
times on the same residue, with a like quantity of 
acid ; crystals will now be produced, which are the 
camphoric acid ; these are to be redissolved in boiling 
water, and again ci7stalhzed. 

Q. What is an ether ? 

A. It is a peculiar fluid formed by the action of an 
acid upon alcohol. It is extremely light and volatile; 
of a peculiar pungent smell, and very inflammable, 
burning with a bright flame. 

Q. What is tin- red precipitate of mercury ? 

A. It is a perox\de of the metal, obtained by ex- 
posing the nitrate of mercury to heat. 



CHEMISTRY. 113 

Q. What are the properties of the white arsenic, or 
arsenous acid ? 

A. It is of a white colour, possesses a freak subacid 
taste, which slowly manifests itself; and it reddens ve- 
getable blues. If placed on burning coals, or a red hot 
iron, it volatilizes in the form of white vapours, which 
have a strong smell of garlic. It unites with many of 
the earths and alkalies, forming saline compounds. 

Q. How may succinic acid be obtained >. 

A. It may be obtained by sublimation, from amber. 
The solid acid thus obtained is to be dissolved in water, 
filtered, and allowed to crystallize. These operations 
are to be repeated until the acid becomes nearly co- 
lourless. 

Q. How many kinds of fermentation are there ? 

A. There are five: viz. the saccharine, producing 
sugar; the vinous, producing wine, beer, &c; the 
acetous, producing vinegar; the putrefactive, producing 
ammonia; and the panary, producing bread. 

Q. What is emetic tartar, chemically speaking ? 

A. It is a tartrite of antimony and potash. 

Q. What is meant by the acetic acid ? 

A. Acetic acid is the acid produced by the acetous 
fermentation in a concentrated state. 

Q. How are the different ethers distinguished ? 

A. They are named after the different acids by which 
they are produced : thus, the ether obtained from sul- 
phuric acid and alcohol, is called sulphuric ether; that 
from the nitric acid, nitrous ether, &c. 

Q. How is the emetic tartar made ? 

A. The best mode is, by boiling together proper pro- 
portions of the pulvis algarothi and supertartrate of 
potash, in solution, straining the liquor thus obtained, 
and allowing it to crystallize. 

Q. What do you mean by the pulvis algarothi ? 

A. It is a white oxyde of antimony, which is produced 
on adding the muriate of antimony to water. 

Q. How is the tartarous acid procured ? 

A. By dissolving in water the supertartrate of pot- 
k 2 



114 CHEMISTRY. 

ash, and adding carbonate of lime by degrees, until the 
liquid is saturated; a precipitate now forms, which is 
the tartrate of lime; very dilute sulphuric acid is to 
be digested on this for several hours, when the tartarous 
acid will be set at liberty, and may be cleared from the 
sulphate of lime, by washing in cold water. 

Q. What ingredients are necessary to produce the- 
vinous fermentation ? 

A. Sugar, mucilage, and water. 

Q How is corrosive sublimate of mercury procured I 

A By triturating together equal parts of dry sul- 
pha i of mercury, and dry muriate of soda, and ex- 
posing t tie mass to heat, in a glass retort, on a sand 
batS. a white salt will now sublime, which is the cor- 
rosive sublimate; 

Q What is corrosive sublimate, chemically speak- 
ing ? 

A. It is a muriate of the red, or peroxyde of mer- 
cury 

(i. What is meant by the lactic acid ? 

A. It is an acid which exists in the whey of milk, and 
is obtained by precipitating it by means or lime, in the 
foirnol lactate of lime, which' is afterwards decom- 
posed by the oxalic acid. 

Q. How is alcohol obtained > 

A. By repeated distillation from any spirituous li 
quor 

Q. What is kermes mineral ? 

A. It is hvdrogenated hydro-sulphuret of antimony 

Q. How is it formed? 

A. By boiling the stilphuret of antimony in a solution 
of pure potash, and filtering the liquor while hot; on 
cooling, the kermes will be precipitated. 

Q. How is the sulphur antimonii precipitahim, or the 
golden stilphuret of antimony, formed ? 

A. Bv adding to the liquor obtained by boiling, the 
sulphuret of antimony in a solution of -pure potash, di- 
luted sulphuric acid; a precipitate of an orange colour 



CHEMISTRY. Hi 

will now be formed, which is the sulphur antimonii pre- 
cipitatum. 

Q. What is meant by the saccho-lactic, or mucous 
acid ' 

A It is an acid obtained by means of the nitric acid 
from gum arabic, and other mucilaginous substances, 
and from the sugar of milk. It is in the form of a 
white gritty powder, with a slightly acid taste. 

Q. Can a fluid, after it has undergone the acetous 
fermentation, be made to undergo a vinous ? 

A. No; fermentation will only take place in the re- 
gular succession from the vinous to the acetous, and 
from the acetous to the putrefactive. 

Q How may boracic acid be procured ? 
A I5y dissolving any quantity of the sub-borate of 
soda in boiling water, and adding to this solution sul- 
phuric acid, by a little at a time, until the solution be 
saturated; it is then to be evaporated slowly to one 
third, and set aside to cool; white scales will now be 
deposited, which are the boracic acid. These &re to 
be re-dissolved, re-crystallized, and lastly, washed, and 
dried on blotting paper. 

Q. What are its properties ? 

A. It appears in the form of brilliant white scales, 
which are soft and unctuous to the touch. It has a 
bitterish taste, with a slight degree of acidity. It is 
soluble in alcohol, which it causes, when set on fire, to 
burn with a green flame. It is of difficult solubility in 
cold water, but is easily dissolved in boiling water. It 
has no action on combustible bodies. 
Q. How is calomel made ? 

A. By rubbing together four parts of corrosive sub- 
limate, and three of quicksilver, and then subliming ; 
or by adding muriatic acid to the nitrate of mercury, 
and washing the precipitate. 

Q. What is calomel, chemically speaking ? 
A. It is a muriate of the black, or protoxyde of mer- 
cury. 
Q. What is the uric, or lithic acid ! 



116 CHEMISTRY. 

A. It is an acid existing in the human urine ; some 
human calculi consist of it entirely. It is a compound 
of carbon, nitrogen, and oxygen. 

Q. How may calomel be distinguished from corrosive 
sublimate by a chemical test ? 

A. To a solution of each add ammonia; with the 
calomel there will be a black, with the corrosive sub- 
limate a white, precipitate. 

Q. How is oxalic acid procured ? 

A. By oxygenizing sugar by means of the nitric 
acid. 



nr 



MATERIA MEDICA 



SECTION IV. 
Examinations in Materia Medico. 

Question. Give a list of the principal emetics. 

Jlrmoer. The principal emetics are, the emetic tar- 
tar (tartris antimonii,) ipecacuanha, and the white 
vitriol (sulphas zinci.) 

Q. What do you mean by cathartics ? 

A. Cathartics are those medicines which have the 
effect of evacuating 1 the intestines downwards ; and 
when they effect this to any considerable degree, it is 
called a purging. 

Q. What is the dose of emetic tartar ? 

A For an adult, from two to five grains, in divided 
doses. 

Q What do you mean by diaphoretics ? 

A. They are those medicines which promote the dis- 
charge by the skin, whether by insensible or sensible 
perspiration. 

Q When is it improper to administer emetics ? 

A They are improper when the stomach is affected 
with active inflammation, or has a great tendency to 
spasm ; in the latter stage of pregnancy, and in cases of 
a very full habit, or where there exists a determination 
to the head ; here bleeding should always be premised. 

Q What is the dose of ipecacuanha as an emetic ? 

A. From fifteen to twenty grains of the powdered 
root. 

Q. What 19 the dose of the white vitriol as an 
emetic I 



113 MAJEUIA MEDINA. 

A. H is generally employed in cases of poison, where 
from one to two drachms should be administered, ac- 
cording to circumstances. 

Q. What are the principal cathartics ? 

A. They are calomel, jalap, rhubarb, magnesia, 
castor oil, sulphur, senna, aloes, gamboge, scammony, 
hellebore, elaterium, supertartrate of potash, and the 
Glauber's, Epsom, Kochelle salts, &c 

Q. What is the dose of ipecacuanha as a diaphoretic? 

A. From half a grain to two grains. 

Q. What is the composition of Dover's powders ? 

A. They consist of ten parts of the sulphas pottassx, 
one of ipecacuanha, and one of opium. 

Q. What is the dose of Dover's powders ? 

A. Ten grains. 

Q. What is the dose o£emetlc tartar as a diaphoretic? 

A. From an eighth to a quarter of a grain. 

Q. What is the composition of the nitrous, or anti- 
monial powders. 

A. They are composed of one drachm of nitre and 
one grain of emetic tartar, for eight powders. 

Q. What is the dose of rhubarb ? 

A. From twenty to thirty grains of the powdered 
root. 

Q,. What are diuretics ? 

A. Diuretics are medicines suited to promote the 
secretion of the urine by the kidneys. 

Q. What is the dose of jalap ? 

A. From fifteen to thirty grains of the powdered root. 

<-i- What are the general rules to be attended to in 
the use of diaphoretics ? 

A. 1st. If the patient's pulse be strong, and the heat 
of the skin considerable, these must be reduced by 
bleeding, &c. previously to the administration of dia- 
phoretics. 2d. During the operation of the diaphoretic, 
the patient must be confined entirely to bed. 3d. To 
excite the action of the medicine, warm dduent drinks 
should be freely allowed. 4th. Where sweating is to 
be kept up for some time, the clothing of the patient 



MATERIA MEDICA. 119 

should be flannel. Finally, carefully guard against a 
sudden suppression of the perspiration. 

Q. What is the dose of calomel ? 

A. From six to fifteen grains. 

Q. Give a list of the principal diuretics. 

A. The principal diuretics are, the supertartras pot- 
tassae, the carbonates of the fixed alkalies, the nitras 
pottassx, the sweet spirits of nitre, digitalis, squill, po- 
lygala senega, and the tincture of cantharides. 

Q. What is the dose of the fixed alkalies as anti 
lithics ? 

A. From ten to twenty grains. 

Q. What is the dose of the supertartras pottassa: as 
a diuretic ? 

A. One ounce in solution, to be given in divided 
doses. 

Q. What is the dose of aloes as a cathartic ? 

A. From five to fifteen grains. 

Q. What is the dose of nitre as a diuretic ? 

A. From ten to thirty grains. 

Q. What is the dose of the nitric and muriatic acids 
as antilithics ? 

A. From fifteen to sixty drops. 

Q. What are the principal diaphoretics ? 

A. The emetic articles, generally, in minute doses ; 
the nitrate of potash, guaiacum, polygala senega, me- 
zereon, sarsaparilla, citrate of potash, &.c. 

Q. What is the dose of magnesia as a cathartic ? 

A. From twenty to thirty grains. 

Q. What do you mean by an antilithic ? 

A. Antilithics are those articles which have a ten- 
dency to correct the lithic diathesis existing in the sys- 
tem, and thereby prevent the formation of urinary cal- 
culi. 

Q. What is the dose of the volatile tincture of guaia- 
cum as an emmenagogue? 

A. About one drachm. 

Q. What is the dose of the carbonated fixed alkalies 
as diuretics > 



120 MATERIA MEDIC A. 

A. From about ten to fifteen grains. 

Q. What is the dose of magnesia as an antiiithic : 

A. From ten to thirty grains. 

Q. What is meant by an emmenagogue ? 

A. Emmenagogu.es are medicines given with the 
\iew of exciting the menstrual discharge. 

Q. What is the dose of digitalis as a diuretic ! 

A. From one to three grains of the powdered leaves. 
and from ten to twenty drops of the tincture. 

Q. What are the principal antilithics ? 

A. The principal antilithics are the carbonated fixed 
alkalies, the super-carbonated alkalies, the aqua pot- 
tassa.-, lime, magnesia, the carbonic, nitric and muriatic 
acids, the hop, &c. &c. 

Q. AVhat is the dose of ergot as an emmenagogue? 

A. From twenty to thirty grains in powder- 

Q. How is the saline draught prepared? 

A. About two ounces of lemon juice is saturated with 
carbonate of potash ; after which, four ounces of water, 
and a sufficient quantity of vinegar, are added. 

Q. What is the dose of squill as a diuretic ? 

A. From two to three grains in powder. 

Q. What are the principal emmenagogues ? 

A. They are ergot, savine, tincture of cantharides, 
calomel, volatile tincture of guaiacum, linctura mulam- 
podii, polygala senega, aloes, and the preparations of 
steel, he. 

Q. What do you mean by anthelmintics ? 

A. Anthelmintics are such medicines as destroy or 
expel worms infesting the human body. 

Q What is meant by narcotics r 

A. They are medicines which diminish the sensibili- 
ty and irritability of the system, allay pain, and induct 
sleep 

Q. What is the dose of cantharides as a diuretic ? 

A- From ten to thirty drops of the tincture. 

Q Give a list of the principal anthelmintics. 

A. They are calomel, the oil of the chenopodium an- 
thelminticum, or the leaves in infusion, the spigelia, the 



MATERIA MEDICA. 121 

bark of the cabbage tree, the root of the male fern, 
cowhage, the root of the melia azedarach, oil of turpen- 
tine, and the different preparations of iron. 

Q. What do you mean by antispasmodics ? 

A. Antispasmodics are medicines which have the 
power of allaying or removing inordinate motion in the 
muscular system. 

Q. Which are the principal narcotics ? 

A. They are opium, hyoscyamus, cicuta, stramoni- 
um, belladonna, tobacco, and the hop. 

Q. What is the formula for the cretaceous mixture ' 

A. It Creta p. p. t 1 oz. 

Gum. arab. 2 dr. 
Sach. alb. 1 dr. 
01. cinnamon 6 git. 
Aq commuu. 12 oz. Al. 
To this may be added, if required, tinctura opii half a 
drachm to one drachm, according to circumstances. 

Q. How is the tinctura opii made ? 

A. By digesting one ounce of opium in one pound of 
proof spirits for four days, then straining. 

Q. How is the tincture of cantharides made ? 

A. By digesting one drachm of the cantharides in a 
pound of proof spirits for three or four days, then strain- 
ing 

Q. How is the liquor arsenicalis, or Fowler's solu- 
tion, obtained ? 

A By taking sixty-four grains of prepared oxyde of 
arsenic, sixty-four grains Of the sub-carbonate of pot- 
ash, and half a pint of distilled water; these are to be 
boiled in a glass vessel until the arsenic is perfectly 
dissolved; when cold, half an ounce of the compound 
spirits of lavender, and as much distilled water as shall 
be required to make the whole measure exactly on* 
pint, are to be added. 

L 



122 



MIDWIFERY. 



SECTION V. 

Examhiations in JMidivifenj. 

Question. Which is the longest diameter of the pelvis, 
and what does it measure ? 

Answer. In the living subject, the diagonal diameter, 
or a line drawn from the sacro iliac symphysis to the 
opposite acetabulum is the longest, it measures about 
five inches and an eighth. 

Q. Which is the longest diameter of the foetal head, 
and what does it measure ? 

A. The longest diameter is from the vertex to the 
chin, and measures about five inches. 

Q. How deep is the pelvis at the sacrum ? 

A. From five to six inches, according as the coccyx 
is more or less extended. 

Q. Which is the shortest diameter of the pelvis, and 
what does it measure ? 

A. The shortest diameter of the pelvis is from the 
symphysis pubis to the projection of the sacrum, mea- 
suring four inches. 

Q. Which is the shortest diameter of the outlet of the 
pelvis, and what does it measure ? 

A. The shortest diameter of the outlet is from one 
tuberosity of the ischium to the other, measuring four 
inches. 

Q. What is the measurement of the foetal head, from 
the root of the nose to the vertex I 

A. Four indies- 



MIDWIFERY. tQ$ 

Q. Wliat is the depth of the pelvis at the symphysis 
pubis ? 

A. About an inch and a half. 

Q. What does the outlet of the pelvis measure from 
the pubis to the coccyx ? 

A. When the coccyx is pushed back it measures five 
inches, but one inch less when it is not. 

Q. What does the fatal head measure from the nape 
of the neck to the vertex ? 

A. Three inches and a half. 

Q. What is the measurement of the lateral diameter 
of the pelvis ? 

A. In the skeleton about five inches and a quarter, 
but somewhat less in the living subject. 

Q. What does the fatal head measure from one pa- 
rieul protuberance to the other? 

A. Three inches and a half. 

Q. What does the foetal head measure from occiput 
to chin along its base ? 

A. Four and a half inches. 

Q. How many inches does the fcetus measure across 
the shoulders ? 

A. Five inches. 

Q. Where is the seat of conception I 

A In the ovaria. 

Q. How soon after conception does the ovum pass 
into the uterus ? 

A. In about three weeks. 

Q. By how many membranes is the fatus in utero 
enveloped ? 

A. By the amnion, the chorion, and decidua reflexa. 

Q. 01 how many parts does the placenta consist ? 

A. 01 two ; the fatal, or the external, with respect 
to the cavity of the uterus, composed of the ramifica- 
tions of the vessels of the chord, and an internal ad- 
hering to the uterus, composed of the ramifications of 
the maternal vessels ; these two portions are connected 
together by a cellular substance. 



iU MIDWIFERY. 

q. Do the vessels of these two portions of tiie pte.- 
centa communicate ? 

A. They have no direct communication j for injec- 
tions thrown in from the maternal vessels will not pass 
^nto the vessels of the foetal portion, and vice versa. 

Q. Of how many vessels is the chord composed 

A. Of two arteries and one vein. 

Q. Describe the fatal circulation. 

A. The blood being brought from the placenta by 
the umbilical vein, passes inio the foetal abdomen at the 
umbilicus, and through a duplica'ure of the falciform 
ligament of the liver to the anterior side of the sinus of 
the vena portarum ; from the opposite side of the sinus 
arises the ductus venosus, which carries the blood to 
the left hepatic vein, through which it passes into the 
ascending cava, and thence to the right auricle of the 
heart The Eustachian vaKe directs a portion of the 
blood of the inferior cava into the left auricle of the 
heart, through the foramen ovale, to be sent to the 
head. The blood of the right auricle passes into the 
pulmonary artery, but in place of being distributed to 
the lungs, passes through the canalus arteriosus, which 
arises near the bifurcation of the pulmonary artery, 
into the aorta, and is, together with the blood from the 
left side of the heart, distributed over the body. The 
blood is carried back to the placenta by the two inter- 
nal iliacs, which, in the foetus, pass up on each side of 
the bladder, and proceeding through the umbilicus, 
constitute the arteries of the chord. 

Q. What is meant by the term quickening ? 

A A peculiar motion or sensation in the womb, 
which is perceived by pregnant women about the fourth 
month. 

Q Upon what does this sensation depend ? 

A. It is occasioned by the uterus at this period sud- 
denly rising above the brim of the pelvis, and encroach- 
lug Mpon the cavity of the abdomen. 

Q. Upon what causes does sterility depend ? 

A, Upon a malconformation, or a' deficiency of tliQ 



MIDWIFERY. i2- 

sexual organs, or upon the functions of these organs 
being disordered or impartially performed, or upon or- 
ganic disease of the parts, or a great exhaustion of 
tin m, arising from frequent and promiscuous venery. 

Q. What do you mean by extra-uterine pregnancy ? 

A. When the ovum, in place of being conveyed to the 
uterus, is either retained in the ovarium, or in the tube, 
or escapes into the cavity of the abdomen, where the 
fcEtus developes itself. 

Q. Which of these species of extra-uterine pregnancy 
is the most frequent ? 

A. That in wnich the ovum is retained in the tube. 

Q. What are the symptoms of extra-uterine preg- 
nancy I 

A. In general, they are those of common uterine 
pregnancy ; they are, however, more violent, and do not 
cease so early ; sometimes, on the contrary, they in- 
crease as pregnancy advances. The menses are not 
interrupted, at least in the first three months. 

Q. How does extra-uterine pregnancy terminate ? 

A. Either by the sac bursting, and the consequent 
hsemorrhagy destroying the woman ; or if this should 
not happen, the foetus may escape through the rupture 
into the abdomen, and become enclosed in a cyst, where 
it may be retained for many years without much incon- 
veniency ; the woman even becoming again pregnant. 
The most common termination, however, is by the sac 
taking on inflammation and adhering to the neighbour- 
ing parts ; suppuration coming on, the foetus, in a pu- 
trid state, is discharged either into the intestines, 
through the sides of the vagina, or externally. 

Q. What do you mean by a retroversion of the 
uterus ? 

A. It is an accident occurring to the impregnated 
uterus, by which its fundus is thrown downwards and 
backwards in the hollow of the sacrum, while the os 
uteri is directed upwards and forwards towards the 
symphysis pubis. 

Q. How is retroversion of the uterus caused ? 

T, 2 



MIDWIFERY. 

A. It is caused by a retention of the mine ; the blad» 
der, as it becomes distended and rises into the abdomen, 
draws with it the neck of the uterus, to which it is at- 
tached, and at the same time throws back the fundus. 

Q. At what period of pregnancy can it take place ? 

A. At any time between the third and fourth months. 

Q. Why cannot it take place after the fourth month ! 

A. Because at this period the uterus lias increased 
so much in size, that it has risen out of the pelvis, into 
the cavity of which it cannot again pass until its con- 
tents are expelled. 

Q. How is a retroversion of the uterus to be treated r 

A. In general, all that is required is to draw off the 
urine with a catheter twice each day, and the uterus, as 
it enlarges, will regain its natural position. 

Q. What is meant by an abortion? 

A. By an abortion is meant tiie expulsion of the foetus 
daring any of the first six months of gestation. 

Q. What ate the general signs of labour ? 

A The first circumstances which lead a woman to 
suspect herself pregnant, are the suppression of the 
menses and an irritable and dispeptic state of the sto- 
mach, particularly in the mornings ; soon after this the 
breasts enlarge, and are occasionally painful ; and the 
nipple becomes surrounded with a brown circle or 
areola ; t he woman becomes paler, and the under part 
• lower eye-lid has a leaden hue ; the features be- 
come sharper, and sometimes the body begins to be 
emaciated, while the pulse becomes quicker; in main 
instances peculiar symptoms take piace, causing sali- 
vation, tooth-ache, &c. ; in other cases but little disturb- 
ance is produced, and the woman has no certainty of 
her condition until the time of quickening. 

Q What is meant by false pains ? 

A. They arc pains arising in the latter period of ges- 
tation, from various causes, and in some degree re- 
sembling those of labour. 

Q. How are tic y io b e distinguished from true la- 
b»ur pains ? 



MIDWIFERY. 127 

A. By their occurring al irregular intervals ; by their 
affecting the bell), more than the back and sides, and 
by their producing no dilatation of the os uteri. 

Q. How are they to be relieved? 

A. If they arise from costiveness, by laxatives ; if 
from acidity in the stomach and bowels, by absorbents ; 
if from spasm or fatigue, by opiates ; and if from in- 
flammation or fever, by bleeding, &c. 

Q. How many presentations of the head are there ? 

A. There are six ; in the. 1st, the posterior fontanellc 
presents behind the left acetabulum, and the anterior 
opposite the right sacro iliac symphysis ; in the 2d, the 
posterior fontanelle is behind the rig-lit acetabulum, and 
the anterior before the left sacro iliac symphysis ; in 
the 3d, the posterior fontanelle presents to the pubes, 
and the anterior to the projection of the sacrum ; the 
4th, 5th, and 6th presentations are the reverse of the 
above ; the anterior fontanelle being in the situation 
of the posterior, and the posterior in the situation of the 
anterior in the 1st, 2d, and 3d presentations. 

Q. How is the anterior distinguished from the pos- 
terior fontanelle ? 

A By the anterior having four angles, and a suture 
proceeding from each angle, while the posterior has 
but three angles, and three sutures proceeding from it. 

Q. Define a natural labour. 

A. A natural labour is one which takes place at the 
end of nine months, in which the vertex presents, and 
the head passes readily into the pelvis, taking such a 
turn as to bring the occiput out under the arch of the 
pubis ; the labour terminates within twenty-four hours 
after its commencement ; the placenta is expelled with- 
in an hour after the birth of the child, and the whole 
process is passed through without danger to the mo- 
ther. 

Q. Into how many stages is labour divided ? 
A. Into four ; 1st', the passage of the head into the 
pelvis ; 2d, its passage through the pelvis ; 3d, the ex- 



128 MIDWIFERY. 

pulsion of the child ; and, 4th, the expulsion of the 

placenta. 

Q. What are the precursory symptoms of labour ? 

A. First, a regular subsidence of the abdomen ; 2d, 
a discharge of a mucous fluid from the vagina ; 3d, 
frequent gripings or tenesmus ; and, 4th, a frequent de- 
sire to void the urine. 

Q. During the dilatation of the os uteri, what kind 
of pains attend ? 

A. Those of a sharp, grinding, or cutting nature. 

Q What kind of pains accompany the expulsion of 
the child ? 

A- Bearing down, or forcing pains. 

Q. What should be the position of the woman during 
the two first stages of labour ? 

A. She may be allowed to occupy any position in 
which she feels most at ease ; if she becomes fatigued, 
she should occasionally repose upon the bed or a couch; 
but it is not expedient, during these two stages, that 
she should remain very long at a lime in a recumbent 
posture. 

Q What food is most proper for a woman during 
labour ? 

A. Such only as is of a mild nourishing nature, such 
as tea, coffee, gruel, barley water, milk and water, &c. 
Of these moderate quantities should be occasionally al- 
lowed, but all spirituous or fermented liquors must be 
strictly forbidden. 

Q. By what means does the practitioner ascertain 
the progress of labour ? 

A. By ascertaining the state of the os uteri, and of 
the presenting part of the child by examination with 
the finger. 

Q. Should we make our examination during or in 
the absence of a pain ? 

A. The linger should be introduced during a pain, 
and retained in until the pain goes off, bv which means 
we ascertain the effect produced on the os uteri, and 
the degree to which it afterwards collapses, and also 



MIDWIFERY, 129 

the exact situation of the presenting part, which cannot 
be done during a pain, lest we prematurely rupture the 
membranes. 

Q, In the commencement of labour, where do we 
find the os uteri ? 

A. In general, directed backwards towards the sa- 
crum 

Q. What is felt between the pubes and os uteri ? 

A. A tumor formed by the neck of the uterus, upop 
which the presenting part of the child rests, and which, 
as labour advances, diminishes in breadth until entirely 
obliterated. 

Q. How is the parturient female to be placed in the 
two last stages of labour ? 

A. Towards the close of the second stage she should 
be placed, on a bed properly made up and secured, 
upon her left side, her legs and thighs somewhat drawn 
up, ard a pillow placed between her knees. 

Q. When the head of the child begins to protrude at 
the os externum, what is to be done ? 

A. The accoucheur should place his hand, covered 
by a soft cloth, in such a manner on the perinseum, as 
to support and guard it from laceration during the ex- 
pulsion of the head and «laoof'the shoulders. 

Q. After the child is completely expelled, what is 
next to be done ? 

A. Whenever it has breathed freely and cried vi- 
gorously, a ligature should be put on the chord, at the 
distance of an inch or so from the belly, and another an 
inch nearer the placenta, and the chord divided between 
them with a pair of sharp scissors. 

Q. If the placenta be not expelled in the usual time 
after the delivery of the child, what conduct should the 
practitioner pursue ? 

A. He should first endeavour to exrite the contrac- 
tion of the uterus by rubbing the belly over it, or by 
pressing it gently with his hand ; should this not induce 
the expulsion of the placenta, and an hour has elapsed 



130 MIDWIFERY. 

since the birth of the child, the accoucheur should pro- 
ceed toexiract it with the hand. 

Q. How is the extraction of the placenta to be con- 
ducted ? 

A. The patient laying still on her left side, with the 
breech very near the edge of the bed, her belly is to be 
moderately pressed by an assistant, while the practi- 
tioner, uncovering his arms, is to take hold of the chord 
with his left hand, while he slowly passes his right, pre- 
viously smeared with lard, into the uterus, making the 
funis his guide ; this action is often sufficient to excite 
the action of the uterus, and occasion the separation of 
the placenta ; but if not, the hand is to be passed on to 
the placenta, and pressed gently against it, while the 
chord is slightly pulled ; when the placenta is by this 
means separated, it is to be taken hold of, and very 
slowly extracted. If, on introducing the hand, it be found 
that the placenta is retained by a spasmodic contraction 
of the uterus at its middle, this contraction is to be gra- 
dually overcome by continued attempts to introduce 
one, two, or more ringers through it. 

Q. What is the proper treatment of the patient after 
delivery ? 

A. After she is somewhat recovered from her fatigue, 
She should be gently turned on her back, and have a 
wide bandage passed around her abdomen, and tightly 
pinned on ; after this the wet bedclothes are to be re- 
moved, and such parts of her dress as have been soiled 
should be taken off, and their place supplied with 
others ; in doing this, we are carefully to avoid raising 
the patient from the horizontal position; by neglecting 
this caution much danger will be incurred, even the 
death of the patient may be occasioned by it. 

Q. How is labour rendered tedious or lingering by a 
weakness of habit in the mother, inducing an inert, ir- 
regular, or partial action in the uterus, to be treated ? 

A. Much time should be allowed for the parts to de- 
velope themselves, the patient's strength being sup- 
ported by mild nourishment, such as gruel, arrow-root., 



MIDWIFERY. 131 

panada, chocolate, he. and it" the pulse allow of it, with 
the addition of a little wine; the bowels are to be open- 
ed by clysters ; the patient should be kept cool, and 
frequently change her position ; as soon as the pa'ls 
are sufficiently dilated, we may administer t« em\ prams 
of powdered ergot, and if it fail to produce sufficient 
contraction of the uterus in the course of half an hour, 
the dose should then be repeated. 

Q. In a tedious labour, arising; from rigidity of the os 
uteri, and other parts concerned in parturition, what is 
to be done ? 

A. Time should be allowed ; the patient being kept 
in an erect posture as much as possible, without fatiguing 
her; her diet should be light; the state of the blad- 
der is to be carefully attended to, that it may not be- 
come over distended, and the bowels must be kept re- 
gular by castor oil or salts. If the patient be of a ro- 
bust habit, bleeding, to some extent, will be found be- 
neficial. 

Q. In the presentation of the anterior fontanelle to 
the right or left acetabulum, can any thing be done to 
accelerate the labour ? 

A Yes ; the presentation may be converted into 
either the first or second, and the labour thus render- 
ed much less tedious and dangerous, by applying the 
fingers to the side of the child's forehead, and pressing 
the anterior fontanelle towards the sacro iliac symphy- 
sis, to which it is inclined. 

Q. How many presentations of the face are there ? 

A Principally four ; viz. with the chin to the pubes, 
with the chin to the sacrum, or with the chin to one or 
other sides of the pelvis. 

Q. How are these presentations to be managed? 

A. We are directed, if possible, to introduce the lever 
or one blade of the forceps over the occiput, and draw 
it down, while with two fingers we push up the chin ; 
by this means we are enabled to convert them into pre- 
sentation of the vertex, when they are to be treated ac- 
cordingly. 



132 MIDWIFERY. 

Q. What is meant by a preternatural labour ? 

A. A labour in which any part of the child except the 
head presents. 

Q. On examining at an early period of labour, what 
would induce you to suspect a mal-position of the 
child ? 

A. If the os uteri be considerably dilated, and yet 
the child cannot be felt ; the liquor amnii being dis- 
charged, while the child remains beyond Mie reach of 
the finger ; the membranes being found hanging down 
in the vagina of a conical form, and small in the diame- 
ter, and especially if the presenting pari, when felt 
through them, be smaller, lighter, and give less resist- 
ance when touched than the bulky head. 

Q. How is a presentation o"f the feet distinguished ? 

A. By feeling, upon examination, the heel and great 
toe ; by the shortness of the toes, and their ends form- 
ing nearly an even line. 

Q. How is a footling case to be managed ? 

A. The management is to be left entirely to nature 
until the nates are born, when, if the back of the child 
present towards the back of the mother, it becomes ne- 
cessary for the accoucheur to take hold of both the 
thighs of the child with a warm napkin, and, during 
the next pain, to give such an inclination to the infant's 
body, as will direct the face towards the mother's 
spine ; during the same pain, in which the practitioner 
produces this turning of the child, the whole body will 
probably be expelled, leaving only the head in the pel- 
vis, with the arms extended on each side of it over the 
ears. It will be better next to bring down the arms, 
bypassing the finger over the child's shoulder as far as 
the bend of the elbow, which is then to be gently de- 
pressed, and the fore arm will in general pass through 
the vagina without much difficulty ; one arm being 
brought down, the extraction of the second is rendered 
more easy. 

Q- Should the expulsion of the head be now left to 
nature ? 



.MIDWIFERY. 133 

A. As the death of the child will be inevitable, from 
the circulation in the chord being put a stop to by 
compression on it, if the head remain any lime in the 
pelvis, we should therefore, when the labour has pro- 
ceeded so far, that only the head remains to be born, 
extract this as speedily as circumstances will admit. 

Q How is this extraction to be effected ? 

A. The left hand of the accoucheur is to be introduc- 
ed into the uterus, and the fore finger being insinuated 
into the mouth of the child, the fore and middle fingers 
of the right hand are to be passed over the nape of the 
neck, one finger resting on each shoulder ; the child 
being supported on the practitioner's left hand and 
arm, a moderate extracting force is now to be employ- 
ed to bring forth the head. This will sometimes be 
more conveniently done, if the woman be turned on her 
back, and the operator stand up. The extraction 
should be attempted during a natural pain, and dis- 
continued as soon as the pain goes off, but in urgent 
cases the extraction must be made without waiting for 
the pains. The operator is to be careful not to use too 
much force in his attempts, otherwise he may strain and 
injure the child's neck, or if he keep the parts con- 
stantly on the stretch, he will so completely compress 
the chord as to stop the circulation and destroy the 
child. 

(-1. How are presentations of the nates distinguished 

A. They are distinguished by the softness, pulpiness, 
and globular shape of the presenting part; by the cleft 
between the buttocks, and by the parts of generation. 

Q. How is a breech presentation to be managed ? 
V During the expulsion of the breech by the efforts 
of the uterus, the perinxum is to be supported, and no- 
thing more is to be done until the knees are so low as 
to be on a line with the os externum ; if they do not 
now naturally bend, and the feet pass out, the finger of 
one hand is to be employed to bend the leg, and bring 
down the foot ; the knee, in this process, pressing ob- 
liquely over the abdomen of the child, the perinxum 
M 



iJ4 MIDWIFERY. 

during the whole time being carefully protected from 
being injured. The case becomes now precisely the 
same as a footling presentation, and is to be treated in 
exactly the same manner. 

Q. How are presentations of the shoulder, arm, side, 
&c- to be managed ? 

A. The accoucheur is to introduce his hand into the 
uterus, and taking hold of the feet, bring them without 
the os uteri, thus converting the case into a presenta- 
tion of the feet, when it is to be managed accordingly. 

A. At what period of the labour should the hand be 
introduced, in order to turn the child ? 

A. It should be introduced previously to the ruptur- 
ing of the membranes, but not until the os uteri is suf- 
ficiently dilated; as a general rule, we may say that the 
proper time for delivery by the feet is " when the os 
uteri has become dilated to the size of half a crown, 
and is at the same time thin and lax." 

Q. What are the cautions to be attended to, in deli- 
vering by the feet ? 

A. 1st, while the hand is in the uterus, not to act 
during a pain, but to keep the hand, in a flattened form, 
close to the body of the child ; 2d, in cases of twins, to 
be careful. that both the feet we have hold of belong to 
the same child; 3d, to bring down the feet over the 
belly of the child, not over its back, and with the toes 
presenting to the back of the mother. 

Q. Provided, in a case of labour requiring turning, 
i lie waters have been evacuated, and the uterus has 
contracted strongly on the child, what is to be done ? 

A. No attempt should now be made to introduce the 
hand, but we should endeavour to relax the action of 
the uterus by bleeding, where admissible, followed by 
a large dose of laudanum ; as soon as the action of the 
uterus becomes suspended, the earliest opportunity is 
then to be taken to deliver. 

Q How are we to conduct a ca9e of twins ? 

A. As the existence of twins cannot be ascertained 
previously to the birth of the first child, this is of coi 



MIDWIFERY. 135 

to be conducted precisely as though there was but one 
child in the uterus ; immediately after the birth of a 
child, the practitioner should in every case satisfy him- 
self that there is no other remaining, by placing his 
hand upon the woman's abdomen, or by introducing a 
finger or two inio the uterus. If there be a second child 
to be delivered, and it presents in such a manner as to 
require manual assistance, or if convulsions, hemorr- 
hage, or any other accident has occurred in the inter- 
val between the two labours, or if the first labour has 
been preternatural, very difficult, or dangerous, the 
practitioner should terminate the second labour as 
quickly as circumstances will admit. If, however, the 
second child present naturally, and the labour of the 
first has terminated without artificial assistance, or 
without much fatigue to the patient, the pains come on, 
in general, soon after the expulsion of the first child, 
and the second is quickly expelled Should the pains 
not, however, come on in a reasonable time, the prac- 
titioner should, after waiting from one to three hours, 
according to circumstances, rupture the membranes, 
when he will commonly find the second child will pass 
readily through the pelvis ; if this, however, be not the 
case, and the head continue high up, he is to turn and 
deliver by the feet. 

Q. How are presentations of the funis to be ma- 
naged ? 

A In general, the best practice is to introduce the 
hand into the uterus, and deliver by the feet ; it is to 
be recollected that the danger in these cases is entirely 
on the side of the child, the operation of turning is 
therefore not to be resorted to if the child is dead, or if 
there be no well-grounded hopes of saving bj it its 
life. 

Q. What are the symptoms attending a rupture of 
the uterus during labour ? 

A The woman has a sensation of something giving 

way internally, preceded by a very sharp pain ; gene- 

•'liy described as a cramp ; this is succeeded by an 



iJo MIDWIFERY. 

immediate cessation of the labour pain, by great Ian 
guor and debility, frequently an instantaneous expul- 
sion of the contents of the stomach, or a vomiting- of a 
brownish fluid, a very quick, weak, and fluttering pulse, 
a cold sweat, and great difficulty of breathing. Upon 
introducing the hand per vaginism, it will in general be 
found that the presenting part of the child, which had 
previously advanced some way into the pelvis, is no 
longer within the reach of the finger, the child having 
passed entirely or partially into the abdomen. 

Q. What is our proper conduct in such a case ? 

A. The hand, if the os uteri be sufficiently dilatable, 
should be introduced, and if the child has only in part 
passed into the cavity of the abdomen, the feet, if within 
reach, are to be taken hold of, and brought down ; or if 
the head of the child be so situated as to admit of the 
application of the forceps, the delivery is to be effected 
by them. Even if the child has passed completely 
through the rent, it will be proper to deliver it by taking 
hold of the feet, provided the hand can be easily intro- 
duced into the cavity of the abdomen, and the accident 
lias not been of long duration, otherwise the case must 
be left to nature- After delivering the child, we should 
carefully examine, in order to ascertain that none of the 
intestines has passed through the rupture. 

Q. What circumstances occasion an hemorrhage to 
take place during labour ? 

A. Either the accidental separation of the placenta 
to a greater or less extent, or its being attached over 
the cervex uteri. 

Q. How is hstnbrrhagy arising from the first cause 
to be treated ? 

A. The patient is to be placed in a horizontal pos- 
ture, but lightly covered with bed clothes : the win- 
dows and doors of the room are to be opened ; cloths 
dipped in cold water should be applied to the abdomen 
and pubes, or even pounded ice itself, inclosed in a bag. 
Should the patient be costive, a pint of cold water, with 
a little salt, may be injected into the rectum ; diluted 



MIDWIFERY. 137 

sulphuric acid may be freely administered in an infu- 
sion of roses, or the sugar of lead may be tried in doses 
of from three to five grains, combined with a small 
quantity of opium, and repeated according to circum- 
blances. 

Q. Provided these measures be incompetent to sup- 
press the hremorrhagy, what must then be done ? 

A. In general, we shall succeed in diminishing or sus- 
pending the flooding by rupturing the membranes, and 
evacuating the waters as soon as a disposition to labour 
comes on ; the uterus will now contract on the child, 
which will, commonly in a few hours, be expelled by 
the natural pains. 

Q. How is haimorrhagy from at) implantation of the 
placenta over the os uteri, to be managed ? 

A. The usual means for checking the hscmorrhagy 
are to be adopted, until the os uteri has a proper degree 
of softness and dilatability, when the hand of the ac- 
coucheur is to be passed into the uterus. If only a por- 
tion of the placenta adhere over the os internum, the 
hand will pass by the side of it, but if the os uteri be 
entirely closed by it, a perforation must be made 
through its substance with the fingers; the hand is 
now to be passed on, until it reach the membranes, 
which are to be ruptured, and the child turned in the 
usual way. 

Q. What are the symptoms of puerperal convulsions? 

A. In cases of true puerperal convulsions, the wo- 
man suddenly loses all sensation, and stretches her- 
self out, every muscle becomes rigid, and a rattling is 
heard in the throat, the muscles are speedily afterwards 
thrown into violent convulsions, the face is livid and dis- 
torted, the eyes are protruded, the woman gnashes her 
teeth and foams at the mouth, a sharp hissing sound is 
produced by her breathing through the closed teeth 
and the foam. This state of convulsion, after lasting 
for some time, gradually ceases, and the patient is left 
in a kind of stupor, during which the breathing is ster- 
orous. In the course of half an hour or so, if there be 



133 MIDWIFERY. 

mo return of Uic convulsions, she gradually reco 
her recollection ; and now complains of great pain in 
her head, and a soreness of her limbs; there is a heavi- 
ness of her countenance, a change in the tone of her 
voice, and a kind of stupidity, which is premonitory of 
a second attack, which in almost every instance takes 
place. Sometimes there is no return to any degree of 
recollection, but one fit follows another for hours, or 
even days, without any perfect intermission. 

Q. How are puerperal convulsions to be treated ? 

A. From thirty to forty ounces of blood should be 
immediately taken from the patient's arm, or the jugu- 
lar veins, and drawn off suddenly by a large orifice. 
The bleeding should be repeated again and again, as 
long as the symptoms remain, with but little abatement. 
If the patient is able to swallow, a large dose of calo- 
mel should be administered, and followed in the course 
of half an hour by a solution of salts, or an infusion of 
senna. If the cathartic cannot be administered by the 
mouth, which is generally the case, a strong purgative 
clyster must be injected, and repeated if necessary. 
The head should now be shaved, and cold applications 
made to it, and if the symptoms continue, a large blis- 
ter. The practitioner should now consider whether it 
will be proper to leave the expulsion of the child any 
longer to nature; if labour be proceeding quickly, it 
will not, perhaps, be necessary to interfere ; but if the 
pains are slow, it is generally proper, as soon as the 
head comes within reach of the forceps, to apply them, 
and deliver without further delay. 

Q. In what cases of labour are the forceps to be re- 
sorted to ? 

A. In every case where it is fully ascertained that the 
natural efforts of the uterus are incompetent to effect 
the delivery of the child; this may arise from either a 
want of power in the uterus, or from a deformity in the 
parts of the mother, or of the head of the foetus. 2d'.y. 
In such cases, where, from certain occurrences, such 



MIDWIFKltV. 159 

»s hxmorrhagy, convulsions, &c. the speedy delivery 
of the child is required. 

Q Mow soon should the forceps he had recourse to ? 

X. Never until the ear of the child, which is nearest 
the pubes, can be felt ; and it is aUb laid down as a 
rule, that, except in cases of Inemorrhagy, convulsions, 
Sec. they should never he applied until the ear has re- 
inained within reach for at least sis hours, during that 
time the head making very little or no progress. 

Q. What are the rules to be attended to in the intro- 
duction of the forceps ? 

A. 1st. Always to introduce them in the axis of the 
superior strait* or in a line from the coccyx towards 
the umbilicus. 2d. To apply the concavity of the for- 
ceps over the convexity of the head. 3d- In their ap- 
plication to keep their points closely applied to the 
child's head. 4th. To use no force in their introduc- 
tion ; and 5th, on locking" the blades, to be careful that 
we do not include in the lock arty of the gbl't parts of 
the mother. 

<-i. Describe the mode of introducing the forceps. 

A. Having ptaced the patient on her left sid'i , with 
the nates close to the edge of the bed; the bladder and 
rectum having been previously emptied, w< are 6o in- 
troduce the tore finger of the right hand, until it reaches 
the child's ear which is nearest the pubes, then taking 
one blade of the forceps in the left hand, > is to be in- 
troduced into the vagina, and caution-,! carried . 
the concavity of the hand until it pa .if of 

the child, beyond which it is to b< tl, un- 

til the lock of the instrument pas lie os 

externum ; the right hand . i, and 

the left, introduced within (lie os uteri} on tl 
side of the head, j this the oi ' the 

forceps is to be passed over the opposite ear or the 
child ; the accoucheur not being able to feel this ear, 
is to be guided in the introduction of the second blade, 
ill a great measure, by the position of tbe first ; both 



UO MimVIFEllY. 

blades being thus introduced, the handles are to be 
brought together and locked. 

Q. If, atter introducing- the forceps, it is found that 
the handles remain some distance from each other, 
what are we to infer ? 

A Either that the forceps embrace the head in a 
wrong direction, or thai the head is seized only by 
their points • no force should therefore be used to bring 
them together, but the second blade should be with- 
drawn, and again introduced. 

Q. Should the handle of the forceps, after their ap- 
plication, come readily in contact throughout their 
whole length ? 

A. No ; when this happens, therefore, we may de- 
pend upon it that the head is not properly included 
within the blades of the forceps. 

Q. In what direction should we act with the forceps ? 

A. Always from handle to handle, consequently, pre- 
viously to the head taking the turn of the pelvis, the 
handles thould be moved from sacrum to pubis, but 
alter the head has turned, from one tuberosity to the 
other. 

Q. What cases of labour require the use of the per- 
forator and crotchet ? 

A. Where the disproportion between the head of the 
child and the size of the pelvis is so great that it is im- 
possible for the head to pass through without being re- 
duced in size; and this may arise from either a distor- 
tion of the pelvis, or the enormous size of the child'b 
head. 



141 



PRACTICE OF MEDICINE 



SECTION VI. 

Examinations on the Practice of Medicine. 

Question. What is the definition of a fever ? 

Answer- It is a disease marked by an increased heat 
,!' the body, and a frequency of the pulse, coming on 
after a sensation of some degree of cold or shivering, 
and attended with a disordered state of several of the 
functions, and a diminution of power in the muscles 
subservient to the will. 

Q. What are the general symptoms of an inflamma- 
tion of the brain, or phrenitis ? 

A. They are a violent fever, severe deep seated pain 
in the head, a redness and turgescence of the face and 
eyes, and an intolerance of light and noise, a constant 
watchfulness, and a furious delirium. 

Q. What are the general outlines of the treatment of 
phrenitis ? 

A. Prompt and copious bleeding, repeated at short 
intervals, until the violence of the disease is subsided, 
followed by active purgatives. The head is to be 
shaved, and cold should be applied to it; after gene- 
ral bleeding, cups to the temples will be proper; 
and as soon as the action of the blood vessels is some- 
what reduced, a blister is to be applied, large enough 
to cover l he whole head ; this, together with the use 
of the antimonial powders, and the strictest adherence 
to the antiphlogistic regimen, constitutes the mode ot 
treating this formidable disc use. 

Q. What is meant by intermittent kve.v' 



142 1'KACTlCK OP MEDICINE 

A. Il is a {'ever in which there is a succession of pa 
roxysms, between which there is a perfect interval, in 
whicli the patient is free from all febrile symptoms. 

Q. What is an e pis taxis I 

A. It is a bleeding from the nose, generally attended 
with pain, and fulness of the head, and some febrile 
symptoms. 

Q. What are the leading symptoms of measles ? 

A. They are fever, generally of an inflammatory type, 
attended with a hoarseness, cough, and other catarrhal 
symptoms; about the fourth day of the disease, an 
eruption of small red spots, which are perceptible to the 
touch, break out over the whole body, and after a con- 
tinuation of a few days, go offin a desquamation of the 
cuticle. 

Q. What is the general plan of treatment in inflam- 
matory eruptive diseases ? 

A By bleeding and purging, carried to such an ex- 
tent as the symptoms shall warrant; the use of the an- 
timonial powders, blisters, and a strict adherence to the 
antiphlogistic regimen. 

Q. What is the definition of a dropsy > 

A. It is a disease in which there is a preternatural 
collection of a serous fluid in the cellular membrane, 
or some one of the great cavities of the body. 

Q. What are the leading symptoms of cynanche ton- 
sillaris ? 

A. They are fever, attended with an acute pain in the 
throat, sometimes darting into the ears; there are a red- 
ness and swelling in the tonsils, palate and fauces, and 
an increase of pain and difficulty in deglutition. 

Q What are the general outlines of the tieatment of 
cynanche tonsillaris ? 

A. Early venesection, both general and local, saline 
purges, the antimonial powders, blisters to the throat, 
and gargles of borax or nitre dissolved in vinegar or 
water, and a strict attention to diet and regimen. 

Q. What is meant by a remittent fever > 

\ ■ By a remittent fever is meant a fever attended 



PRACTICE OF MEDICINE. 143 

with exacerbations and remissions, but in which there 
ia no perfect intermission of the symptoms. 

Q. What are the leading symptoms of acute he- 
patitis ? 

A. A pain more or less acute in the right hypochon- 
drium, increased by pressure on the part, and frequent- 
ly extending to the top of the right shoulder; there is 
a difficulty of respiration, a dry cough, uneasiness on 
laying on the affected side, considerable fever, and a 
frequent, strong, and hard pulse. 

Q. How many species of hepatitis are there ? 

A. There are two, an acute and chronic. 

Q. How may hepatitis be distinguished from spasm 
on the gull ducts ? 

A. By the absence of nausea, by the permanency of 
the pain, by the frequency of the pulse, and by the pa- 
tient preferring a straight position of his body; where- 
as, in case of spasm ot the gall ducts, he finds the most 
easy posture is with his body bent forward on his 
knee*. 

Q. What is the treatment of acute hepatitis \ 

A. Copious and repeated bleedings, both general and 
local, at an early period of the disease, purging by 
means of calomel, blisters to the region of the liver, the 
antimonial powders, and the antiphlogistic regimen. 
If the disease should not give way after these remedies 
have been fully employed for several days, a slight sali- 
vation should be induced, and kept up for some time. 

Q. What is the treatment proper in chronic hepatitis I 

A In the treatment of chronic hepatitis, mercury is 
generally resorted to ; the bowels are at the same time 
to be kept open by the use of laxatives. If there be 
any local uneasiness, blisters will be proper. The pa- 
tient should wear flannel next his skin; make use of 
such food as is easy of digestion, and should carefully 
shun late hours, and the night air 

Q. What is meant by hectic fevtv? 

A. It is a i'tivcr occurring from local irritation in a 
debilitated habit, and is attended with a frequent, small 



FKALilUi Of MI.OiUM, 

pulse, loss of appetite, nausea, a moisture of the skin, 
a circumscribed redness of die cheeks, a copious flow 

<>(' urine, a clean moist tongue, night sweats, watchful- 
ness, diarrhoea, great emaciation, and throughout its 
course by frequent chills, succeeded by flushes of heat. 

Q. i)oa il arise from an absorption of pus, as some 
'nave suppos 

A. No; this is proven by the fact that hectic fever 
may exist in cases where no pus exists, as it does in the 
disease o. the knee joint, previous to suppuration ; and 
that frequently a huge collection of matter is absorbed, 
without inducing hectic, as we see in buboes, 8cc. 

Q. How is hectic i'o be distinguished from intermit- 
tent lever, to which it bears some resemblance ? 

A. By the irregularity of its paroxysms ; by the ap- 
petite for food not being so much impaired as in inter- 
mittent fever ; by the tongue being moist and free from 
fur, and by the circumscribed redness of the cheeks in 
the hectic. 

Q. What are the general symptoms of cynanche 
trachealis ? 

A. They are great difficulty of breathing, attended 
with a peculiar wheezing, hoarse inspiration ; there is a 
loud, shrill, ringing cough, and fever. The acute stage 
of the disease, if not arrested by art, generally termi- 
nates in the exudation of a layer of coagulable lymph, 
mi the lining membrane of the trachea, &c. 

Q. What are the leading symptoms of scarlatina ? 

A. There is fever, and in general a soreness and 
swelling of the fauces and throat, and a bright scarlet 
eruption pervades the whole body, including the face 
and limbs, which, after three days continuance, goes 
off in a desquamation of the cuticle. 

Q. How may scarlatina be distinguished from the 
measles ? 

A. By the eruption in scarlatina appearing on the 
second day of the disease, in the measles not until the 
fourth ; by the difference of the colour of the eruption 
in the two diseases, it being of a bright scarlet in scar- 



PRACTICE OP MEDICINE. 145 

latina, in the measles of a dark raspberry colour ; by 
the skin feeling rough in the measles, owing to the eleva- 
tion of the eruptions, but smooth in the scarlatina ; last- 
ly, by there being little or no catarrhal symptoms pre- 
sent in the scarlet lever. 

Q. What is a dysentery ? 

A. It is a febrile disease, attended with severe grip- 
ing pains in the bowels ; a frequent desire to evacuate 
the intestines, without the ability on going to stool, of 
passing any thing but a little mucus, frequently streak- 
ed with blood. The feces, when they are evacuated, 
appearing in the form of hard balls, denominated scy- 
ballx. 

Q. How may dysentery be distinguished from diarr- 
hoea ? 

A. By the absence of pain, fever, and tenesmus in the 
latter, and by the discharge from the bowels being 
(cecal. 

Q. What are the outlines of the treatment of dysen- 
tery > 

A. Bleeding at short intervals, proportioned to the 
degree of inflammation, as indicated by the pain and 
lever, followed by cathartics, which operate freely, 
without occasioning much griping. These should be 
continued until the stools assume a natural appearance. 
\fter the force of the disease is somewhat reduced, the 
antimonial powders should be administered, and a large 
blister applied to the abdomen. If the symptoms do 
not speedily yield, mercury is to be employed, so as 
to induce a salivation. After the inflammatory symp- 
toms have been subdued, and nothing remains but a 
looseness and tenesmus, opium will be proper, either 
in injections, or by the mouth. The tone of the intes- 
tines are to be restored by the use of tonics, blisters, 
the cold bath, exercise, &c. 

Q. What is meant by tenesmus ? 

A. An inordinate desire to go to stool, without the 
power of evacuating the intestines. 

Q. How is cholic to be distinguished from enteritis ? 
N 



146 PRACTICE OF MEDICINE. 

A. By the pain in the former being fixed and con- 
stant, and increased upon pressure ; whereas in the lat- 
ter, the pain is at intervals, and of a peculiar twisting 
nature, alleviated by pressure, and accompanied by an 
irregular contraction of the abdominal muscles. 

Q. What are the symptoms of pleurisy ? 

A Fever ; pain in the thorax, increased upon a full 
inspiration, and by coughing ; difficulty of respiration ; a 
cough, at first dry, but afterwards accompanied by an 
expectoration; a difficulty of laying on the affected side, 
and a full, frequent, and hard pulse. 

Q. How is pleurisy to be treated ? 

A. By very copious bleeding, from a large orifice, re- 
peated at short intervals, until the pain and difficulty 
of breathing are subdued; by blisters to the affected 
side, and by the antimonial powders ; the bowels are 
to be kept open, and the patient confined to a strict an- 
tiphlogistic regimen ; the cough should be relieved by 
some demulcent mixture. 

Q. When gangrene takes place in an internal part, 
what are the symptoms ? 

A. Sudden cessation of pain, a peculiar appearance 
of the countenance, cold perspiration, coldness of the 
extremities, hiccup, subsultus tendinum, suppression of 
urine, convulsions, and a scarcely perceptible pulse. 

Q. What is meant by diabetes ? 

A. It is a disease attended with a frequent and very 
copious discharge of urine, which is generally of a sac- 
charine nature; and a voracious appetite. 

Q. How many species of diabetes are there ? 

A. There are two ; viz. diabetes mellitis and diabetes 
insipidus ; in the one the urine discharged being sac- 
charine, in the other not. 

Q. How may gout be distinguished from rheu- 
matism ? 

A. By the pains in gout being preceded by some disor- 
der of the stomach, which is not the case in rheumatism; 
by the pains in the gout affecting the lessei joints, par- 
ticularly of the extremities, whereas, in the rheuma- 



PRACTICE OF MEDICINE. 147 

asm, the larger joints are their seat ; and in the gout 
the affected parts are redder, and more swoHen than in 
rheumatism. 

Q. What are the outlines of the treatment of active 
haemorrhages ? 

A Active haemorrhages are to be treated by bleed- 
ing and purging, and the antiphlogistic plan gene- 
rally ; by the local application of cold, and the admi- 
nistration of certain remedies, as common salt in sub- 
stance, sugar of lead, alum, digitalis, and opium. 

Q. What is meant by pyrosis ? 

A. It is the discharge of a glairy fluid from the sto- 
mach by eructation, with a sense of burning in the epi- 
gastric region and dyspepsia. 

Q. What are the symptoms of haemoptysis ? 

A. There is in general a pain, or a sense of uneasi- 
ness in some part of the thorax; difficulty of breathing; 
a saltish taste in the mouth, succeeded by a discharge 
of blood from the lungs, of a florid colour, and often 
froth v, brought up with more or less hawking. 

Q. How many species of worms infest the human in. 
testiivs ? 

A. Three round ; \\z. the lumbricoides, ascarides, 
and trichures : and two flat, viz. the tenia and cucurbi- 
tinae. 

Q. How may an incisted abdominal dropsy be distin- 
guished from ascites ? 

A If the general system appear to be little affected ; 
if the patient's strength and appetite be not much im- 
paired, and the sleep be but little interrupted ; if the 
tumor of the abdomen was at first confined to one par- 
ticular part ; if the menses in the female continue to 
flow as usual ; if there be no anasarca, or if it is con- 
fined to the extremities, and there is no leucophlegma- 
tic paleness, or sallow colour of the face ; if there he 
no fever, nor much scarcity of urine, there will be rea- 
son to suspect the disease to be of the incisted kmd, 

Q. Hpw many kinds of catarrh are there ? 



US PRACTICE OF MEDICINE. 

A. Two ; viz,, catarrhus a frigore, and catarrhus epi- 
demicus, or the influenza. 

Q. What is meant by scrofula ? 

A. It is a peculiar affection of the lymphatic system, 
attended with an enlargement of the conglobate glands, 
which runs on to an imperfect suppuration ; it affects 
persons of peculiar habits, and is hereditary. 

Q. What are the indications of cure in catarrh ? 

A. To reduce febrile action by the usual remedies, 
and to allay the irritation of the affected parts by de- 
mulcent mixtures. 

Q. What are the leading symptoms of apoplexy ? 

A. They are a sudden loss of sense and voluntary 
motion, the action of the heart and arteries still con- 
tinuing, with a stertorous breathing, and a turgid and 
flushed countenance. 

Q. What is the mode of treating apoplexy ? 

A. After removing all ligatures from about the neck, 
and placing the patient in an erect posture, he is to be 
bled copiously, both from the arm, and by cups from 
the temples and occiput; if the patient can swallow, an 
active purge should be administered ; if not, a strong 
clyster. Sinapisms should be applied to the extremi- 
ties ; the head is to be shaved, and cold applied to it ; 
and, after sufficient evacuation, a large blister. 

Q How may haemoptysis be distinguished from hx- 
metemesis ? 

A. By the blood in the latter disease, in place of be- 
ing in small quantities, of a florid, red colour, mixed 
with a little frothy mucus, and brought up by cough- 
ing, as in hemoptysis, being thrown up by vomiting, in 
large quantities, of a dark colour, and mixed with the 
contents of the stomach, and unattended with cough. 

Q How many species of cholic a-e there ? 

A. There are three ; the bilious, the flatulent, and 
the cholica pictonum. 

Q. What is the general mode of treating the cholica 
pictonum } 

A. By bleeding, according to circumstances ; by the 



PRACTICE OP MEDICINE. 149 

administration of purees, and by the use of" mercury, so 
as to excite a salivation ; by warm fomentations to the 
abdomen, and aftervvaids a blister. 

Q How can acute be distinguished from chronic 
rheumatism ? 

A. While the pains are unfixed, readily changing 
their place; when they are greater in the nighttime; 
when, at the same time, they are attended with fever, 
and with pain and redness of the joints, the disease is 
to be considered as acute But when there is little or 
no fever remaining ; when the affected joints are without 
redness, and are cold and stiff; when, while a free 
sweat is excited on the rest of the system, the affected 
joints are only cold and clammy, and especially when 
the pains are increased by cold and relieved by heat, 
the case is to be considered as purely chronic. 

Q. What do you mean by an anasarca ? 

A A dropsy, or morbid collection of water in the 
cellular membrane of the whole, or a part of the body. 

Q. What are the leading symptoms of hydrocephalus? 

A. They are languor, inactivity, loss of appetite, 
nausea, vomiting, obstinate costiveness, parched tongue, 
dry skin, and other febrile symptoms ; violent and con- 
tinued pain in the head, particularly across the b-ow, 
stupor, suffused redness of the eyes, great sensibility, 
and aversion to light, suddenly interrupted sleep, with 
violent screaming, convulsions, and dilated pupils 

Q. What are the outlines of the treatment of hydro- 
cephalus ? 

A. In the first stage, it is to be treated by prompt 
and efficient depletion j by bleeding, both general and 
local, purging with calomel, followed by a solution of 
salts, by blisters, &c. After effusion has taken place, 
mercury should be exhibited in such a manner as to in- 
duce a speedy salivation. 

Q. What are the general symptoms of gastritis and 
enteritis ? 

A. They are, fever, a constant acute pain in some 
part of the abdomen, increased by pressure on the part, 



150 PRACTICE OF MEDICINE. 

nausea, vomiting, obstinate costiveness, and a small, 
frequent, and contracted pulse. 

Q. What are the outlines of the treatment of gastritis 
and enteritis ? 

A. Copious and early bleeding, repeated at short in- 
tervals, as long as the symptoms continue with Tittle 
abatement, followed by local bleeding from the abdo- 
men, and afterwards the application of a large blister 
to the part ; after the nausea and vomiting are some- 
what abated, we may resort to purgatives, in order to 
remove the costiveness. Tbe patient should, at the 
same time, be confined to a strict antiphlogistic regi- 
men. 

Q. What is meant by an antiphlogistic regimen ? 

A. The antiphlogistic regimen consists in avoiding, as 
much as possible, 1st, all impressions on the external 
senses, such as heat, light, noise, &c. ; 2d, all motion 
of the boly ; the patient should therefore be placed in 
that position which puts in action fewest of the mus- 
cles, and he is to be debarred from talking ; 3d, all ex- 
ercise of the mind ; 4tb, all kinds of food and drink, 
excepting such as are of the mildest and least stimu- 
lating kind, such as toast and water, rice water, barley 
water, apple water, &c and even of these, but a small 
quantity should be allowed. 

Q. How may typhus be distinguished from a fever of 
an inflammatory type ? 

A. By the more sudden accession of the latter dis- 
ease ; by its arising from sudden alterations of tempe- 
rature, the application of cold to the body when heat- 
ed, violent exercise, intemperance, &c, and not from 
contagion ; by the strength of the body not being so 
much diminished, and by the hardness of the pulse, the 
whiteness of the tongue, and the high colour of the 
urine. 

Q. Describe the progress of the arm after vaccina- 
tion. 

A. About the third day after the insertion of the vi- 
rus, the puncture becomes inflamed, and feels hard to 



PRACTICE OF MEDICINE. 151 

the touch ; on the next day the red point is a little in- 
creased in size, and somewhat radiated ; between the 
fifth and sixth days there is a small circular or slightly 
oval vesicle, of a dull pearl white colour, containing a 
limpid fluid, acquiring, about the tenth day, a dia- 
meter equal to about the third or fourth of an inch ; 
until the end of the eighth day its surface is even, be- 
ing depressed in the centre, but on the ninth day it be- 
comes flat, or sometimes rather higher in the middle 
than at the edges, the margins are turgid and round, 
and project a little over the base of the vesicle ; on the 
eighth or ninth day the vesicle is surrounded by an are- 
ola of an intensely red colour, and the parts covered 
by it are tumid and hard ; on the eleventh or twelfth 
day, as the areola decreases, the surface of the vesicle 
becomes brown at the centre, and is not so clear at the 
margin, the cuticle gives way, and there remains a firm 
and glossy mahogany coloured scab, which is not de- 
tached in general until the twentieth day. 

Q,. What are the general symptoms of epilepsy ? 

A. A sudden deprivation of the senses of the patient, 
accompanied with violent convulsions of the whole body; 
these after a time go off, leaving the patient in general 
in his usual state, but sometimes a considerable degree 
of sVupor and weakness remains behind, particularly 
when the disease has been of frequent occurrence. 

Q. What is meant by ascites ? 

A. It is a morbid collection of water in the cavity of 
the abdomen. 

Q. What are the general symptoms of hydrothorax, 
or dropsy of the chest ? 

■■» A. Thev are, anxiety at the lower end of the sternum, 
succeeded by a difficulty of respiration, particularly on 
motion, or when in a horizontal posture; difficulty of 
laying on the side opposite to that in which the effusion 
exists ; sudden starling from sleep, with anxiety, a 
sense of suffocation, and palpitation ; irregularity of the 
pulse, cough, occasionally syncope, ocdematous swell- 
ing, thirst, and a diminution of urine, which is high 



152 PRACTICE OF MEDICINE. 

coloured, and deposits, on cooling, a reddish sediment. 
The most decisive symptom is a sensation of a fluctuat- 
ing fluid being experienced in the chest on certain mo- 
lions of the body. 

Q. How is tympanites distinguished from ascites ? 

A. By the absence of fluctuation, and of those symp- 
toms which characterise the hydroptic diathesis. 



THE END 



ERRATA. 

Page 17, in the answer to the 4th question from the bottom of the page, 
for •' coroco braehillis," read " coraco brnc-Jiin lis." 
64, tenth line from the foot of the page, for " fot wards" read 

" outwards." 
77, ninth line from the foot of the page, for "cremasti," read 
" cremaster." 
102, in the answer to the second question from the foot of the page, 

for " oxylate" read " oxalate." 
107, ninth line from the tup for "oxygen" read " nitrogen." 
120, in the answer to the 6th question from the top of the page, for 
'[ vinegar" read " sugar." 



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celebrated writers. In two volumes, handsomely 
printed, and bound in one large volume. 

Cullen's Materia Medica, by Dr. Barton, 2 vols.- 



Cm-lie on the Climate and Diseases of the U. States, 

8vo. 
Currie on Bilious and Remitting Fever, 8vo. 
Currie 's Reports on Water in Fevers, 8vo. 
Conversations on Chemistry, 2 vols. 
Cleghorn's Minorca, 12 mo. and in 8vo. 
Cooper's Surgery. 
Copeland on the Rectum. 
Caldwell's Medical Theses, 2 vols. 
Oheyne on Hydrocephalus, 12mo. 

on Croup, 12mo. 
Gullen's Nosology. 

< oxc's Philadelphia Medical Dictionary, containing a 
concise Explanation of all the terms in Medicine, 
Hurgery, Pharmacy, Botany, Natural History, Che- 
mistry and Materia Medica, compiled from the best 
authorities ancient and modern. 
Duncan on Consumption, 12mo. 
Darwin's Zoonomia complete, three parts bound in 

two. 
Dorsey's Elements of Surgery, 2 vols. 
Denman's Midwifery, 8vo. 

Desault on Fractures and Luxations, by Caldwell, 8vo. 
Desault's Surgical Works ; or statement of the doc- 
trine and practice of P. J. Desault, Surgeon in chief 
of the Great Hospital of Humanity at Paris, by Xa- 
vier Bichat, his pupil, adjunct Physician of the same 
hospital. Translated from the original, by Edward 
Darrell Smith, M. D. Professor of Chemistry, &c. in 
the South Carolina College, in 2 vols. 8vo. with 
plates. 
Edinburgh Medical and Surgical Journal, 8vo. now 

publishing. 
I'.clectic Repertory and Analytical Review, Medical and 
Philosophical, by a Society of Physicians in Phila- 
delphia, published in quarterly numbers, making 
one volume a year ; the 8th volume of this valuable 
work is just published. 
Ferrier's Medical Histories, 4 vols, in one. 
Fordyce on Fevers. 
Coodlad on the Absorbent System. 



Gregory's (Professor, of Edinburgh) Dissertation on 
the influence of Climate in the cure of Diseases, 
translated by JJarton. 

Hamilton's Midwifery, with Smellie's plates, 8vo. 

Hamilton on the management of Female Complaints,. 
12mo. 

J ley on Puerperal Fevers, 8vo. 

Hamilton on Purgative Medicines. 

Hooper's Anatomist's Vade Mecum, 12mo. 
Physician's Vade Mecum, 8vo. 

Hamilton on Diseases of Infants. 

Hunter on the Venereal. 

Haller's Plates of the Arteries. 

Home on Cancer. 

Hey's Surgery Plates. 

Hooper's Medical Dictionary. 

Hi bpj 's Chemistry, by Dr. Coxe, 8vo. new edition. 

Home on Ulcers. 

Hillary on Diseases of Uarbadoes, by Rush. 

lnnes on the Muscles, l2mo. 

Jones on the process employed by Nature in Sup- 
pressing the Haemorrhage from Divided and Punc- 
tured Arteries ; and on the use of the Ligature. 
With Observations on Secondary Hemorrhage : the 
whole deduced from an extensive series of Kxperi- 
ments, and illustrated by fifteen plates, 8vo. in 
boards. 

Carrey's Surgery, 2 vols. 8vo. 

Lindon Hot Climates. 

London Dissector. 

Le Gallois on Life, 8vo. 

Medical Repository, (New York) 18 vols. 8vo. con- 
tinued quarterly. 

Murray's Materia Medica and Pharmacy, with Notes by- 
Professor Chapman, 2 vols. 8vo. 

Motherby's Medical Dictionary, improved by Parr, 2 
vols. 4to. plates. 

Murray on the Arteries. 

Medical Dictionary. 

Maclean on Hydrothorax. 

New England MedicalJournal, published quarterly. 



Practice of Physic, (the modern) exhibiting the clu 
racters, causes, symptoms, prognostics, morbid ap- 
pearances, and improved method of treating the dis- 
eases of all climates. By Robert Thomas, M. D. of 
Salisbury, England. Abridged from the fifth and 
last London edition, by William Currie and David F. 
Condie, Physicians, Philadelphia. 
Parkinson's Medical Admonitions, 8vo. 

Chemical Pocket Book, 12mo. 
Parke's Chemical Catechism, 8vo. 

Grammar of Chemistry. 
Phillips' Mineralogy, plates. 
Pemberton on the Viscera 8vo. 

Practical Chemistry, or a Description of the Processes 
by which the various articles of Chemical iFsaearcb. 
in the animal, vegetable and mineral kingdoms are 
procured, together with the best mode of Analysis ; 
translated from the French of P. M. Orfila, by John 
Uedman Coxe, M. D. ; to which is added, a variety 
of subjects of Practical Utility ; and a copious Glos- 
sary of Chemical Terms and Synonimes; just pub- 
lished, with 8 plates, 8vo. 
Quincey's Medical Lexicon, 8vo. 
Reid on Consumption, 8vo. 

Richerand's Elements of Physiology, now complete, 
translated by De Lys, with notes and illustrations by 
Dr. Chapman. 
Rush's Works, 2 vols. 8vo. 

on the Diseases of the Mind, 
on Ardent Spirits, 12mo. 
Pringle on Diseases of the Army 
Sydenham. 
Hillary. 
Cleghorn. 

Introductory Lectures and Syllabus. 
Saunders on the Liver, 12mo. 
Senac on Fevers, translated by Caldwell, 8vo. 
System of Anatomy, from the Encyclopedia, with 12 

large copperplates, 8vo. 
Scofield on Vaccination. 
Swediaur n the Venereal, a new tend much improved 



edition, by the author, translated by Dr. Hewaon. 

Saunders on the Eye. 

Therapeutics, Elements of, by Professor Chapman. 
Timbrel on Ruptures, 12mo. 
Thomas on Inflammation, 8vo. 
Trotter on the Nervous Temperament. 
Thompson's Chemistry, by Cooper, new edition. 
Thomas's Practice, abridged by Drs. Currie and Condie. 
Underwood on the Diseases of Children, 8vo. 

Surgical Tracts, 8vo. 
Webster Medicines Praxeos Systema, 2 vols. 8vo. 
Wilson on Fevers, 2 vols. 
Wistar's System of Anatomy, 2 vols. 8vo. 
Woolcombe on Consumptions. 
Ware"®»4he Eye, 2 vols. 

Zoonomia by Darwin, Part 2d, being the Theory and 
Practice of Physic, 2 vols. 8vo. 

All new Medical Publications as they appear. 

J. TV. has in fircss and will shortly /uiblish, 
Pole's Surgery, with A r otes by Sir James Earlc. 






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